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Fracture Repair 2 > Bone Grafting > Flashcards

Bone Grafting Flashcards

1
Q

What is bone grafting and the point of it?

A

Bone grafting involves the transplantation or implantation of bone or bone substitute to enhance bone healing or replace missing bone.

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2
Q

Define autograft

A

From the same animal

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3
Q

Define allograft

A

From a different animal

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4
Q

Define xenograft

A

From different species

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5
Q

What are the types of autograft most commonly used? (3)

A

Cancellous
Cortical-cancellous
Cortical (vascularised, non-vascularised)

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6
Q

What are the types of allograft most commonly used? (3)

A

Cancellous bone chips
Cortical grafts
Demineralised bone matrix

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7
Q

What type of growth factor graft is commonly used?

A

Bone morphogenic proteins

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8
Q

What is the commonly used synthetic graft?

A

Hydroxyapatite

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9
Q

What are the 4 possible properties of a bone graft?

A
  • Oestoconduction
  • Osteoinduction
  • Osteogenesis
  • Osteopromotion
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10
Q

What is osteoconduction?

A

Provision of a scaffold matrix for mesenchymal stem cells and their progeny to migrate into and proliferate with.

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11
Q

Osteoconduction:
Materials may or may not impart A) characteristics during bone regeneration, may or may not be B) , and may be naturally occurring

A

A) load-bearing
B) absorbable

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12
Q

What is osteoinduction?

A

These materials recruit mesenchymal stem cells or their progeny to infiltrate the material or tissues (chemoattraction and migration), and then they induce multipotential cells to multiply and become cells that make up the regenerating bony callus (proliferation and differentiation).

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13
Q

What is osteogenesis

A

Formation of new bone by the graft; the graft must contain viable osteoblasts or stem cells that can differentiate into osteoblasts.

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14
Q

Osteopromotion can be achieved by

A

introduction of substances or materials that enhance bone regeneration or by physical or mechanical strategies that induce proliferation and differentiation of mesenchymal stem cells and their progeny.

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15
Q

Examples of osteopromotive (3)

A

platelet-rich plasma
hydrogels
biphasic calcium phosphate.

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16
Q

What bone grafts are considered the gold standard? Why? (3)

A

Autogenous cancellous bone graft
Properties: osteogenic, osteoconductive and osteoinductive

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17
Q

Disadvantages of autogenous calcellous bone graft? (6)

A
  • 2nd surgical site
  • increased surgical time
  • increased cost
  • increased morbidity
  • pain
  • risk of # at donor site
18
Q

How to avoid # at donor site of autogenous cancellous bone graft? (2)

A

Small hole as poss
No levering

19
Q

Properties of allografts? (2)

A

Osteoconduction
Osteoinductive

20
Q

Advantages of allografts? (2)

A
  • no 2nd surgical site
  • Not volume limited
21
Q

Why is osteogenesis impossible with allografts (3)

A

Frozen, demineralised or irradiated (eliminated living cells)

22
Q

What is the property of growth factors?

A

osteoinductive

23
Q

Synthetic graft example? (4)

A

Ceramics
Injectable Calcium Phosphate
Bioactive glass
Glass ionomer cements

24
Q

True or False
Historically, synthetic grafts have suffered from poor clinical results, unpredictable resorption rates and inflammatory reactions

A

True

25
Q

Indications for bone graft? (6)

A
  • Complex fractures
  • Fractures with poor healing potential
  • Filling of bone defects
  • Arthrodesis
  • Intervertebral fusion
  • Treatment of delayed or non-union.
26
Q

Minimum time between collection of bone graft from same site?

A

3mo

27
Q

Autogenous cancellous bone grafts (5)

A

Proximal lateral humerus (base of the greater tubercle)
Ilial wing (dorsal or lateral) (Cortico-cancellous bone graft)
Proximal lateral femur
Distal femoral condyle
Medial proximal tibia

28
Q

What is the donor site of the proximal humerus?

A

Greater tubercle

29
Q

Where is the level of surgical approach to the proximal humerus?

A

Greater tubercle - Level of the tendon of insertion of the infraspinatus muscle. (3cm incison cranial to deltoid m)

30
Q

On the surgical approach to the proximal humerus:
How is the lateral cortex penetrated? (3)

A

Steinmann pin, hand chuck or drill by directing the tip of pin/drill away from the shoulder joint.

31
Q

On the surgical approach to the proximal humerus: What is used to graft the bone?

A

Use a Spratt Volkmann type curette

32
Q

How to store a bone graft once collected? (2) when to use?

A

Store the graft in the barrel of a 5- or 10-mL syringe by placing it along the plunger, to keep the graft material moist and protected.
Moist bloody swab

  • USE ASAP
33
Q

On the surgical approach to the proximal humerus:
Retractor type?

A

x 2 gelpi at orthogonal

34
Q

How to close bone graft site?

A

-fascia and skin

35
Q

What is the minimum time interval that should be allowed if repeating the harvesting bone graft from the proximal humerus?

A

8 weeks

36
Q

Cortico-cancellous bone graft collection from the ilial wing
Where is it approached?

A

Elevate soft tissues from the cranial dorsal region of the iliac spine.

37
Q

Cortico-cancellous bone graft collection from the ilial wing
- What is used in cats?

A

Ronguer;

38
Q

Cortico-cancellous bone graft collection from the ilial wing
- What is used in dogs and what is removed?

A

Saw/osteome to remove v shaped; then harvested using curette

39
Q

What is used to retract the gluteal muscle during cortico cancellous bone graft of ilieal wing?

A

Hohmann

40
Q

When considering bone grafts and their substitutes what best describes osteogenesis?

A

Osteogenesis describes the formation of bone at the recipient site by supplying bone forming cells in a graft material.

41
Q

You perform a pantarsal arthrodesis with a medially applied plate in a 2-year-old domestic shorthair cat to treat a chronic instability of the joint due to collateral ligament injury. You collect an autogenous cancellous bone graft, which you keep in a sterile syringe case.

How should it be placed? When to and not to flush?

A

Pack over the joint spaces cranial and caudal of, and around the plate.

Flush the surgical site before placing the graft.

Do not flush after graft placement.

Fracture Repair 2 (10 decks)

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