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Ortho > Bone healing > Flashcards

Bone healing Flashcards

1
Q

Why do we do anatomical reduction for Intraarticular fractures?

A

To reduce the risk of secondary osteoarthritis

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2
Q

Anatomical reduction is done for which type of fractures?

A

Intra-articular

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3
Q

Functional reduction is done for which type of fractures?

A

Shaft fractures

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4
Q

What is absolute stability?

A

No movement at the fracture site

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5
Q

What is relative stability?

A

Minimal movement at the fracture site

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6
Q

Which fractures require absolute stability?

A

Intra-articular

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7
Q

Which fractures require relative stability?

A

Epiphyseal or metaphyseal

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8
Q

The timing to start mobilization depends on:

A

The stability of the fixation

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9
Q

What is the aim of mobilization?

A

To start as early as possible in order to avoid complications like joint stiffness

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10
Q

For a fracture to properly heal, it needs:

A

1) Good blood supply
2) Stability
3) Good bony opposition (bone on bone contact)

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11
Q

What are the types of fracture healing?

A

1) Primary (Direct)
2) Secondary (Indirect)

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12
Q

Secondary bone healing occurs in which type of stability?

A

Relative stability

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13
Q

Primary bone healing occurs in which type of stability?

A

Absolute stability

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14
Q

If someone has a cast, what type of stability is this?

A

Relative

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15
Q

Someone wearing a sling would go through which type of bone healing?

A

Secondary

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16
Q

Which methods provide relative stability?

A

1) Cast
2) Sling
3) Intramedullary nails
4) K-wires

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17
Q

Primary bone healing is only possible with:

A

1) Fracture gap <2mm
3) Motion at the fracture site <1mm

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18
Q

What is consolidation?

A

Restoring pre-fracture strength

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19
Q

What are the 4 stages of bone healing?

A

1) Hematoma formation & Inflammation
2) Soft callous
3) Hard callous
4) Remodeling

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20
Q

How is granulation tissue produced in bone healing?

A

Hematoma + necrosis release cytokines that:
1) Attract macrophages
2) Promotes neovascularization

= Granulation tissue produced

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21
Q

What invades the granulation tissue when forming the soft callous?

A

1) Fibroblasts
2) Chondroblasts
3) Osteoblasts

22
Q

When does the fracture become sticky (soft callous)?

A

When the fibrous tissue is replaced by cartilage

23
Q

How does the soft callous becomes a hard callous?

A

When the cartilage is replaced by woven bone

24
Q

Bone healing between fracture ends resembles:

A

Endochondral ossification

25
Q

Remodeling is best in: (!!!)

A

1) Younger children
2) Fractures close to the growth plate

26
Q

What remodeling characteristics of bone facilitates early load and weight bearing?

A

1) Progressive mineralization of the woven callous
2) Its protuberant shape

27
Q

What characteristics of remodeled bone are suboptimal?

A

1) High cellularity and water content
2) Amorphous arrangement of collagen fibers
3) Patchy pattern of matrix mineralization

28
Q

The hard callous is replaced gradually with ___ according to:

A

Lamellar bone; Stresses applied upon it.

29
Q

What does osteoclastic resorption do?

A

Removes extraneous peripheral bone that isn’t necessary for optimal mechanical function

30
Q

What is absent in primary bone healing?

A

Massive callous formation

31
Q

What gradually disappears in primary bone healing?

A

Small fracture lines

32
Q

What is the Haversian remodeling?

A

The coordinated activity of osteoblasts and osteoclasts to resorb and replace existing cortical bone.

33
Q

What is primary bone healing responsible for?

A

The perpetual turnover of the skeleton

34
Q

Primary bone healing is a temporary acceleration of:

A

Haversian remodeling

35
Q

Primary bone healing is carried out by:

A

Bone metabolizing units

36
Q

Bone metabolizing units contain what at the front end?

A

Cutting cones

37
Q

Bone metabolizing units are lined by:

A

Multicellular osteoclasts

38
Q

What is the linear rate of bone resorption?

A

50µm/day

39
Q

Behind the bone metabolizing units, walls of osteons are lined by:

A

Osteoblasts

40
Q

Osteoblasts produce osteoid at a rate of:

A

1µm/day

41
Q

Which 3 tools are used for absolutely stable fractures?

A

1) Lag screws
2) Compression plates
3) Tension band wiring

42
Q

What are the complications of fracture healing?

A

1) Malunion
2) Nonunion

43
Q

What is malunion?

A

Good healing but in an inappropriate position = Compromises the function

44
Q

What is the treatment for malunion?

A

Osteotomy (break the bone) and fixation in the right position

45
Q

What are the types of nonunion?

A

1) Hypertrophic
2) Atrophic

46
Q

Where does the problem lie in hypertrophic nonunion?

A

Inadequate stability of the fracture site (Callous is formed but can’t hold the ends together)

47
Q

Where does the problem lie in atrophic nonunion?

A

Inadequate vascularity at the fracture site = necrosis at fracture ends

48
Q

What sign is seen on the x-ray in hypertrophic nonunion?

A

Elephant foot or horse hoof appearance

49
Q

Treatment of hypertrophic nonunion?

A

Surgical stabilization of the fracture

50
Q

What sign is seen on the x-ray in atrophic nonunion?

A

Pencil like appearance of fracture ends

51
Q

Treatment of atrophic nonunion?

A

1) Debridement of the necrotic bone ends
2) Bone grafting
3) Fixation

Ortho (5 decks)

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