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RUSVM Small Animal Surgery 2017 > Bone Healing > Flashcards

Bone Healing Flashcards

1
Q

Osteoblasts Function

A 
Produce osteoid (unmineralized bone matrix) on bone surface to form Haversian System 
Transport Calcium and phosphorus from extracellular matrix into osteoid seam
High levels of protein synthesis
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2
Q

Osteocytes

A

Osteoblasts that have been encased in mineralized matrix

House in lacunae with cytoplasmic processes within canaliculi

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3
Q

Osteocytes function

A

Maintain bone matrix

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4
Q

Osteoclasts

A

Large multinucleated cells derived from pluripotential cells of bone marrow
Active in areas of bone remodeling

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5
Q

Osteoclasts function

A

Resorb bone through degradation of: Collagenous proteins, Non-collagenous proteins, and Bone Minerals

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6
Q

Phases of Bone Healing

A

Inflammatory Phase
Repair Phase
Remodeling Phase

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7
Q

Inflammatory Phase

A

Death of osteocytes at results in release of lysosomal enzymes
Necrotic material at site of fracture is source of inflammatory response
Release of acute phase proteins
Release of growth factors form platelets, macrophages, granulocytes, and lymphocytes
Osteoclasts resorb and remove devitalized bone at fracture ends

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8
Q

How long does the inflammatory phase last?

A

2-3 weeks

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9
Q

Repair Phase

A

Migration of osteoprogenitor cells to form external periosteal callus
Angiogenesis results in transient blood supply from surrounding soft tissues
Chondro-, fibro-, and osteoblasts inhabit callus producing collagen
Deposition of calcium hydroxyapatite in matrix resulting in callus mineralization - rapid increase in stability
Cartilage replaced by bone via endochondral ossification

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10
Q

Remodeling Phase

A

Begins when fracture is bridges by callus
Woven bone remodeled into lamellar bone via action of osteoclasts and osteoblasts
Slow process directed by stresses of weight bearing

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11
Q

What are the primary/direct types of bone healing?

A

Gap Healing

Contact Healing

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12
Q

Contact Healing

A

Occurs under compression of bone ends under rigid fixation
No cartilaginous callus formed
Cutting cones form across fracture line followed by longitudinal deposition of lamellar bone

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13
Q

Gap Healing

A

Gap between fracture ends less than 1 mm
Granulation tissue at gap followed by transversely oriented lamellar bone
Haversarian remodeling occurs at 3 weeks post stabilization

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14
Q

Secondary Bone Healing

A

Fracture ends do not touch
Micromotion at fracture promotes formation of callus - Results in release of growth factors that promote bone union
Bone heals via mineralization of fibrocartilaginous callus into bony callus

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15
Q

Why are fracture ends not compressed?

A

Protection of surrounding soft tissues

Protection of blood supply at site of fracture

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16
Q

MIPO

A

Minimally Invasive Plate Osteosynthesis

17
Q

What is used in secondary bone healing?

A

Plates in Bridging Mode
External Skeletal Fixation
Interlocking nails

18
Q

What is the average healing time of fractures?

A

6-8 weeks

19
Q

What are the factors that affect bone healing?

A 
Fracture configuration/severity 
Soft tissue damage 
Stability of repair 
Presence of Infection 
Patient factors 
Compliance
20
Q

A’s of evaluation of bone healing

A

Alignment
Apposition
Apparatus
Activity

21
Q

Assessment of Bone Healing

A

Lysis
Periosteal reaction
New Bone formation
Bone resorption

22
Q

Delayed Union

A

Healing is prolonged beyond normal expected time course
Fracture line remains evident with feathery/wooly ends
Callus is visible but lacks appropriate mineralization
No sclerosis of bone ends

23
Q

Sclerosis

A

no blood supply to the fracture

24
Q

Malunion

A

Failure to re-establish normal form and function in the face of healing

25
Q

Nonunion Viable

A

Biologically active fracture with cartilage and fibrous tissue between fracture ends

26
Q

Nonunion Nonviable

A

Fracture ends are sclerotic with rounded bone edges and visible fracture gap

27
Q

Characteristics of Nonviable Nonunion fractures

A

Dystrophic
Necrotic
Defect
Atrophic

28
Q

Treatment of Delayed Union

A

Bone grafts
Increased mechanical stiffness of implants
Bone morphogenic protein

29
Q

Treatment option of Non-union

A

Rigid stabilization
Removal of loose implants
Encourage biologically active environment: Bone graft, Bone marrow, Demineralized bone matrix, Bone morphologenic proteins
Removal of non-viable bone

30
Q

What are other options for treatment of non bone healing?

A

Extracorporeal shock wave therapy
Pulsed Electromagnetic Field
Low intensity pulsed Ultrasonography

RUSVM Small Animal Surgery 2017 (17 decks)

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