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Ortho > Bone Graft Properties > Flashcards

Bone Graft Properties Flashcards

1
Q

What do bone grafts provide?

A
  • mesenchymal stem cells, osteoblasts, growth factors, bone for scaffold dependent on the graft
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2
Q

What is osteogenesis and what type of graft provides it?

A
  • New bone development and support via osteoblasts

- Cancellous autograft

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3
Q

What is osteoinduction and what type of graft provides it?

A
  • Ability to induce migration and differentiation from mesenchymal stem cells into osteoblasts
  • Example is demineralized bone matrix (bone morphogenic proteins)
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4
Q

What is osteoconduction and what type of bone graft provides it?

A
  • Ability of a material to provide a scaffold for host bone invasion
    e. g. Cortical allograft
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5
Q

What is osteointegration?

A
  • Surface bonding between graft and host bone
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6
Q

WHere do you get autogenous cancellous bone grafts from?

A
  • Proximal humerus
  • Proximal tibia
  • Ilium
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7
Q

How do you get autogenous cancellous bone?

A
  • IM pin and curette
  • He mixes bone marrow and the autogenous cancellous bone together
  • Helps to speed it up and provides osteogenesis
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8
Q

What does demineralized bone matrix provide?

A
  • Osteoinductive with bone morphogenic proteins

- Osteoconductive with scaffolding

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9
Q

How do you use demineralized bone matrix?

A
  • Mix with blood

- Used a lot

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10
Q

What does a cancellous autograft provide?

A
  • Osteogenesis, osteoinduction, and osteoconduction
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11
Q

What does a cortical autograft provide?

A
  • Osteogenesis, osteoinduction, and osteoconduction (to a lesser degree)
  • Also has strength
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12
Q

What is radiographic union?

A
  • Point at which healing has progressed that there is evidence of bone bridging of all fracture lines in all views
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13
Q

What is clinical union?

A
  • Point at which healing has progressed to the point in strength that the fixation can be removed
  • You could let that patient go back to normal
  • We are interested in this one
  • DOn’t want to let them go back to completely unrestricted until radiographic union, but can let them go back to somewhat normal at clinical union
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14
Q

Rate of union for clinical union using ESF and IM pins

Age:

  • <3 months
  • 3-6 months
  • 6-12 months
  • > 1 year
A

<3 months: 2-3 weeks

3-6 months: 4-6 weeks

6-12 months: 5-8 weeks

> 1 year: 7-12 weeks

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15
Q

Rate of clinical union for direct healing

Age:

  • <3 months
  • 3-6 months
  • 6-12 months
  • > 1 year
A
  • <3 months: 4 weeks
  • 3-6 months: 2-3 months
  • 6-12 months: 3-5 months
  • > 1 year: 5 months to 1 year
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16
Q

Delayed union

A
  • Fractures that heal more slowly than anticipated
  • Progressive signs of bone activity if visible on radiographs and bone union is anticipated by not ensured (e.g. around 8 weeks post casting don’t see union)
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17
Q

What is #1 reason of delayed union, and what can you do to alleviate?

A
  • # 1 reason is lack of stability

- Increase rigidity

18
Q

Reasons for delayed union in general

A
  • Systemic status of the patient
  • Nature of the trauma
  • High energy fracture, soft tissue trauma, open?
  • Poor decision making in fracture management (too rigid, unstable, large fracture gap, radiation therapy)
  • Drugs (Steroids, NSAIDs
19
Q

What is nonunion?

A
  • Arrested fracture repair process
20
Q

How do you correct a nonunion?

A
  • Requires surgical intervention to achieve healing
21
Q

What is the general cause of a nonunion?

A
  • Usually result of poor decision making and technical failure on the part of the surgeon
  • Instability at the fracture site is the most common reason for a non-union
22
Q

Hypertrophic non-union

A
  • Large amounts of non-bridging callus
23
Q

How to treat a hypertrophic non-union?

A
  • Debridement, grafting, and stabilization
24
Q

Atrophic nonunion

A
  • Biologically inactive pseudoarthrosis

- No evidence of bone reaction at the fracture site, and bone ends appear sclerotic

25
Q

Malunion

A
  • Healed fractures in which anatomic bone alignment is not achieved or maintained during healing
26
Q

What is impact of malunion on function?

A
  • Deleterious effect on function
  • Severe malunions can cause arthritis of the affected joint due to the malalignment and joint incongruity
  • Need a corrective osteotomy
  • Likely need to be referred
27
Q

Osteomyelitis definition

A
  • Inflammatory condition of bone and medullary canal
28
Q

Etiologies of osteomyelitis

A
  • Bacterial or fungal (mostly bacterial; German Shepherds are at higher risk for fungal)
  • Acute hematogenous vs post-traumatic (acute or chronic)
29
Q

What is the etiology of most post-traumatic osteomyelitis?

A
  • Bacterial infection

- Biofilm

30
Q

What is a biofilm?

A
  • Biofilm is bacteria, glycocalyx, and implant surface

- Protects the bacteria from antimicrobials and host defenses

31
Q

Clinical signs of osteomyelitis

A
  • Pain, tenderness, swelling, erythema (acutely)

- Drainage (chronically

32
Q

Lab findings of osteomyelitis

A
  • No significant findings on bloodwork often

- might see a left shift

33
Q

Diagnostics for osteomyelitis

A
  • Culture and sensitivity prior to antibiotics (best to aspirate down to the fracture site rather than swab the draining tract)
  • Radiographs: varies with the stage of disease (Perisoteal reaction; sequestrum are possible findings)
34
Q

Treatment for osteomyelitis

A
  • Surgical debridement to healthy, bleeding bone
  • Establish drainage (closed suction drains preferred)
  • Re-stabilize
  • Antibiotics for 4-6 weeks based on culture
35
Q

Osteomyelitis and implants

A
  • If implants are stable, leave in place until the fracture heals
  • Infection will not clear until implants are removed
  • If unstable, stabilize or remove and replace (you can add an external skeletal fixator)
36
Q

Indications for implant removal

A
  • Clinical union
  • Radiographic union
  • Growing animal/open physis
  • Interference with function (if they seem bothered)
  • Pain
  • Unstable or loose implants
  • Infection is not an indication for implant removal
  • If infection is present once healing has occurred, the implant may need to be removed
37
Q

Causes of pathologic fractures

A
  • Neoplasia (often)
  • Osteomyelitis
  • Bone cyst
  • Radiation therapy
38
Q

Radiographic features of pathologic fracture

A
  • Lytic/proliferative bone (classic for a tumor)
  • Periosteal reaction
  • Soft tissue mass
39
Q

Quadriceps contracture

A
  • Unstable fracture in a young dog

- Leg remains extended

40
Q

Sciatic nerve entrapment

A
  • Not uncommon with pinning a femur

- This is why you should try to place a pin in the femur normograde

41
Q

Ankylosis of joint

A
  • Can occur secondary to fracture repair

Ortho (10 decks)

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