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MSK > Bone Growth and Fracture Healing > Flashcards

Bone Growth and Fracture Healing Flashcards

1
Q

What are the two types of bone growth?

A

Intramembranous

Endochondral

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2
Q

What type of bones are formed by endochondral and how?

A

Long bones
Induce to cartilage which secretes collagen grows and is replaced with bone and blood vessels invade
Continuously renews
Stops when hyaline fully converts to bone

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3
Q

What type of bones are formed by intramembranous bone growth and how?

A 
Flat bones, clavicle
Pluripotent cells --> position, condense, align and secrete ECM
Osteoblasts form bone matrix
Lamella added to trabecula
Form lattice structure
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4
Q

Features of cortical bone?

A

Found in diaphysis
Resists bending and torsion
Laid down circumferentially
Less biologically active

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5
Q

Features of cortical bone?

A

Metaphysis
Resists/abdorbs Compression
Site of longitudinal growth
Very biologically active

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6
Q

What is a fracture?

A

Break in structural continuity of bone

May be crack, break, split, crumpling, buckle

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7
Q

Why do bones fail?

A

High energy transfer in normal bones
Repetitive stress in normal bones
Low energy transfer in abnormal bones (osteoporosis, osteomalacia, met tumour, other bone disorders)

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8
Q

What are the stages of fracture repair?

A

Inflammation
Soft callus
Hard callus
Remodelling

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9
Q

What are the features of first stage?

A

Haematoma and fibrin clot
Platelets, monocytes, macrophages
Haematoma infiltrated with fibrovascular tissue –> callus

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10
Q

What are features of the second/third stages?

A

Soft to hard callus
Forms at bone ends
Soft callus can easily bend
Hard callus can withstand more = clinical union

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11
Q

What are features of the fourth stage?

A

Bone thats no longer needed removed, woven bone –> lamellar bone
Medullary canal reconstituted

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12
Q

How can we affect bone repair at stage 1?

A

NSAIDs decrease blood flow therefore risk of healing failure (also in an open fracture or surgery)
Can give platelet concentrations to stimulatee repair (PDGF, IGF, VEGF)

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13
Q

How can we affect bone repair at stages 2/3?

A 
Replace cartilage (DBM)
Bone graft or substitutes 
(autogenous cancellous or allograft bone)
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14
Q

What is delayed union?

A

Failure to heal in expected time

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15
Q

What increases the change of delayed union?

A 
High energy injury
Distraction
Instability
Infection
Steroids
Immune suppressants
Smoking, NSAIDs, warfarin
Ciprofloxacin
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16
Q

What is non union?

A

Failure to heal

Failure calcification fibrocartilage

17
Q

What can non union cause?

A 
Instability
Abundant callus formation
Pain + tenderness
Persistent fracture line
Sclerosis

MSK (27 decks)

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