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Recon > Bone Grafts And Orthobiologics > Flashcards

Bone Grafts And Orthobiologics Flashcards

1
Q

What are some benefits of bone grafts

A
  • important in treatment of nonunion
  • Fill large defects
  • Structural integrity
  • Increase vascularity
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2
Q

What is the gold standard for bone grafts

A

Authogenous grafts

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3
Q

Describe the properties of Autogenous grafts

A
  • osteogenic
  • osteoconductive
  • osteoinductive
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4
Q

What are some common sites for harvesting Autogenous bone grafts

A

Calcaneus
Tibia
Fibula
Iliac crest

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5
Q

What is the importance of the cortical portion of the corticocancellous bone grafts

A

Structure and length

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6
Q

What is the importance of the cancellous portion of corticocancellous bone in a bone graft

A

BMP mediates osteoprogenitor/MSCs, necessary for incorporation

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7
Q

What is the trephine technique

A
  • percutaneous
  • largely cancellous,
  • good for small defects
  • can be mixed with other products
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8
Q

What is the maximum free graft that can be interposed/implanted

A

2.5cm

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9
Q

If greater than 2.5cm of bone graft is needed, what can be done

A
  • onlay/inlay graft
  • bone transport
  • vascularized graft
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10
Q

What are the properties of allogenic grafts

A
  • osteoinductive
  • osteoconductive
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11
Q

What is the advantages of allogenic grafts

A
  • no donor sire morbidity
  • decreased OR time
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12
Q

The success of orthobiologics depends on what

A
  • vascularity
  • surgical intervention with adequate preparation
  • proper alignment
  • application of stable fixation
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13
Q

What is he make of of osteoinductive orthobiologics

A
  • PRP
  • BMP
  • Growth factors
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14
Q

Wha is the make up os osteoconductive orthobiologics

A
  • DBM
  • Bioceramics
  • Bioglass
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15
Q

What is the make up osteogenic orthobiologics

A
  • Mesenchymal stem cells
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16
Q

Describe the osteoinductive PRPs

A

Platelet Rich Plasma
- used for bone, ligament and tendon healing
- centrifuging the patient’s blood to separate out and obtain a gel-like concentration of growth facts
- PRP injected in and around the surgical site

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17
Q

How many BMPs are recognized and how play a role in bone healing

A
  • 20 recognized
  • 7 play a role in bone healing
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18
Q

The BMPs that play a role in bone healing belong with which family

A

TGF-beta superfamily

19
Q

Describe osteoinductive growth factors

A
  • naturally occurring and are prominent at various phases of the healing process
20
Q

What happens when PDGF is combined with tricalcium phosphate

A

An osteoinductive and conductive substrate is produced

21
Q

What is osteoconductive DBM

A

Processed allograft - lacks mineralization but retains growth factors and collagen

22
Q

Describe how DBM is prepared

A
  • combinations of acids or detergents/solvents
  • antibiotics and freeze dryin
23
Q

Is DBM osteoconductive or osteoinductive

A

Can be both osteoconductive and osteoinductive

24
Q

What is the disadvantage of sterilizing DBM with gamma irradiation, formaldehyde and/or ethylene oxide prep?

A

It will strip the osteoinductive properties of DBM

25
Q

What is one benefit of DBM

A

It comes in many forms: gel, putty, sheets and chips, different strengths and pliability

26
Q

What are the most common materials for osteoconductive Calcium based bioceramics

A
  • hydroxyapatite **
  • tricalcium phosphate **
  • ceramics
  • fibrillation collagen
  • and/or coralline hydroxyapatite
27
Q

What are the two important considerations for osteoconductive calcium based bioceramics

A
  • calcium-phosphate ratio
  • Pore size of the graft
28
Q

Why is the calcium-phosphate ratio of calcium based bioceramics important

A
  • it dictates the rate of absorption
  • when filling a bone void, the rate of resorption cannot exceed the rate of bone deposition because that will destroy our scaffolding
29
Q

What is the ideal and most widely accepted resorption to bone deposition ratio

A

1.5 - 1.67

30
Q

Why is pore size of the calcium based bioceramics graft important

A
  • pore size is critical to allow influx of appropriate cells and growth factors and subsequent osteogenesis
31
Q

What is the idea pore size of calcium based bioceramics graft that have yielded better angiogenesis and healing

A

300 micrometers or greater

32
Q

What is one benefit of using calcium sulfate and calcium phosphate in combination as a bone graft

A

Greater compressive strength

33
Q

Which bone graft may be combined with antibiotics to treat infections while serving as a filler?
What does that mean for Autogenous graft?

A

Bioceramics
Decreases the need for Autogenous graft

34
Q

What is the advantage of using bioceramics combined with antibiotics over polymethylmethacrylate beads

A

Bioceremics are absorbable and does not need removal

35
Q

What is osteoconductive bioglass made of

A

Calcium
Phosphorous
Silicon dioxide

36
Q

Which graft has osteoconductive and osteointegrative properties

A

Bioglass

37
Q

What is the importance of the osteoconductive and osteointegrative properties of the bioglass

A

Binding with hydroxyapatite forming a scaffold for healing, which is subsequently resorbed

38
Q

What is the importance of the calcium phosphate deposition from bioglass

A

Attracts osteoblasts which results in electrical bone growth stimulation

39
Q

Which bone graft has intrinsic antomicrobial activity due to the additional bactericidal activity from its components

A

Bioglass - possible enhance bone tissue regeneration

40
Q

What is a key feature of Osteogenic MSCs

A

Can differentiate into osteoblasts and chondroblasts

41
Q

What is a common source of osteogenic MSCs

A

bone marrow aspirate (BMA)
- tibia using jamshidi or syringe

42
Q

What is BMA containing MSCs typically combined with

A

DBM or calcium-based bioceramics - to get all three components we’re looking for

43
Q

What is the risk associated with allogenic MSCs

A

Cross-reactivity

44
Q

Is the chance of cross-reactivity in allogenic MSCs high

A

Studies show low potential for rejection as well as high content of viable cells at time of implantation with resultant osteogenesis

Recon (10 decks)

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