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ACVS Phase II 2023 Case Based Only > Bone Healing > Flashcards

Bone Healing Flashcards

1
Q

Field and Ruthenbeck, VCOT, 2018:
Pattern of optical density measures during fracture healing?
Correlation between optical density measures and the qualitative measure of bridging callus and the radiographic union score for tibial fractures (RUST)?

A

Field and Ruthenbeck, VCOT, 2018:
Optical density measures decreased through 4 weeks post-op (resorptive phase) and then gradually and consistently increased at 8-16 weeks post-op
Optical density measures showed strong correlation with measures of bridging callus and RUST

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2
Q

Yeh JAVMA 2021

Time to fixator removal in cats

Factors associated with PO complications

A

Time to fixator removal in cats
-8 weeks

Factors associated with PO complications
-BW
-tibial fracture
-use of type 2 fix
-use of destabilization

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3
Q

Guidelines for using locking plates

A
  1. Spanning long segments of bone (3x the length of fractured segments)
  2. Limiting screw-to-hole ratio to less than 0.5
  3. Limiting distance between plate and bone to 2 mm
  4. Leaving 2-3 screw holes empty over the fracture
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4
Q

How to make a plate construct stiffer

A
  1. Larger plate
  2. Shortening working length (placing screws closer to fracture ends)
  3. Adding implants (IM pin, second plate)
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5
Q

Construct stiffness is maximized if screws are placed where?

A

At the end of the plate and near the fracture

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6
Q

There is little mechanical advantage to placing more than _____ screws per fracture segment with respect to _________

A

3

Axial stiffness

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7
Q

Placing a ______ screw per fragment increases ____________

A

4th

Torsional rigidity

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8
Q

Screws should be omitted from holes closest to fracture gap in what size gap

A

1mm

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9
Q

Star drives allows for how much greater torque than hex heads

A

65%

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10
Q
A

a) SOP

b) ALPS

c) Fixin

d) PAX

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11
Q

Bridging plate

Plate span ratio
-comminuted
-simple fractures

Screw density

A

Plan span ratio
-comminuted 2-3
-simple fractures 8-10

Screw density
0.5 to 0.4

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12
Q

The addition of an IM pin to a bridging plate effect

A

Reduces strain = Fatigue life of plate increased

Improves overall stiffness = risk of plastic deformation decreases

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13
Q

Minimal screw for plate rod

A

One bicortical
One monocortical

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14
Q

Disadvantages of Ex Fix

A

-Increase risk for infection
-external and eccentric placement of fixation = large bending moment on fixation pins

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15
Q
A

Type: Ia
Pins: Half
Connecting Bars: 1
Pin Geometry:
-Unilateral uniplanar

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16
Q
A

Type: Ib
Pins: Half
Connecting Bars: 2
Pin Geometry:
-unilateral biplanar

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17
Q
A

Type: I-II
Pins: Half and 1 full
Connecting Bars: 2
Pin Geometry:
-bilateral uniplanar

18
Q
A

Type: II modified
Pins: Half and 2 full
Connecting Bars: 2
Pin Geometry:
-Bilateral uniplanar

19
Q
A

Type: II
Pins: Full
Connecting Bars: 2
Pin Geometry:
-Bilateral uniplanar

20
Q
A

Type: III modified
Pins: Half and full
Connecting Bars: 3
Pin Geometry:
-Bilateral biplanar

21
Q

Forces stabilized by Ex Fix

A

Compression
Shear
Torsion

22
Q

Ex Fix Configuration for Radius

A

I
Ib
Acrylic
I-II hybrid
II

23
Q

Ex Fix Configuration for Tibia

A

I
Ib
Acrylic
I-II hybrid
II
III
Circular
Arches
Combined Nail ESF

24
Q

Strategies to Preserve the Pin-Bone Interface of ESF

A

1) Increase the strength of the pin-bone interface junction and pin-pull out strength

2) Decrease the load and bending forces per pin

25
Q

Pin placement configuration for ESF application

A

Far pins first
-nearest joints
-3/4 bone diameter away

Near pins second
-closest to fracture
-1/2 bone diameter away

26
Q

Increase the strength of the pin-bone interface junction and pin pull-out strength of ESF

A

Pin type:
-threaded over smooth

Pin size:
-threaded portion 20-30% bone diameter

Pin placement:
-Central placement through widest part of bone

Insertion techniques:
-Predrill w/ bit 0.1 mag smaller than pin shaft
-Insertion speed < 300 rpm
-Proper insertion force

27
Q

Decrease the load and bending forces per pin in ESF

A

Adequate pin number:
-3-4 pins per fragment

Decrease the pin working length:
-Place clamp with bolt toward patient, no more than 1 cm from surface of skin

Pin configuration and frame stiffness:
-Far-near-near-far pin placement
-Consider multiplanar frame
-Consider augmentations (articulations, diagonals, IM pin)

28
Q

Interlocking Nails resists

A

Bending
Rotation
Axial load

29
Q

Indications for locking Nail

A

Closed comminuted diaphyseal fracture long bones

30
Q

Fracture pattern
Type of mechanical loading

A

Transverse fracture

Tensile loading

31
Q

Fracture pattern
Mechanical loading

A

Oblique fracture
Compressive loading

32
Q

Fracture pattern
Mechanical loading

A

Spiral fracture
Torsional loading

33
Q

Fracture pattern
Mechanical loading

A

Transverse fracture
Bending forces

Small butterfly comminution

34
Q

Fracture pattern
Mechanical loading

A

Comminuted fracture
Combined loads

35
Q

Humerus simple transverse fracture

A

IM pin & unilateral ESF

36
Q

Humerus simple short oblique

A

Nail
Plate
Plate and pin

37
Q

Humerus simple long oblique

A

IM pin, cerclage wire
Nail & cerclage
Lateral or craniolateral plate and Lag screws

38
Q

Humerus mild comminution-reducible

A

Lag screws and plate
ESF and IM pin
Nail

39
Q

Humerus severe comminution-irreducible

A

Bridging plate-lateral or medial
Bridging plate & IM pin
ESF and IM pin
ESF- unilateral w/ bilateral transcondylar pin
ESF with double bar
Nail

40
Q

Femoral diaphysis fracture repair

A

Bone plates
Plate-Rod constructs
IM pin and cerclage wires
Stack pinning
Nail
ESF

ACVS Phase II 2023 Case Based Only (22 decks)

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