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BASIC TRAINING > Bone Healing and Spinal Fusion > Flashcards

Bone Healing and Spinal Fusion Flashcards

1
Q

Grooves and holes allow for _______

A

The passage of blood vessels and nerves.

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2
Q

What are the 5 categories bones are divided into?

A
  1. Long bones
  2. Short bones
  3. Flat bones (sternum, pelvis, skull)
  4. Irregular bones (vertebrae)
  5. Sesamoid bones (Bones are those that are completely surrounded by tendon)
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3
Q

2 Different types of bone in the body

A
  1. Cortical (dense, compact bone)

2. Cancellous (more vascular + maybe some bone marrow)

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4
Q

Osteons

A

Concentric layers of bone, or lamellae, arranged around a Haversian canal - which contains blood vessels and nerves.

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5
Q

Osteocytes

A

Bone Cells

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6
Q

Volkmann’s canals

A

Channels that run perpendicular to the Haversian Canals, allowing blood vessels to travel from the outside of the bone to the center.

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7
Q

Another name for Lamellar Bone

A

Cancellous Bone

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8
Q

Bone Composition is ____% ______ and ____% ______.

A

70% Inorganic and 30% Organic

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9
Q

___% of inorganic components of bone consist of

A

95%….of Hydroxyappetite

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10
Q

____% of the organic components of bone consist of _____.

A

93% of….consists of Collagen

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11
Q

Collagen

A

Primary structural material. It is a protein with great tensile strength, and is the main component of bone, cartilage, ligaments, tendons, and teeth. Collagen is the foundation of bone upon which the minerals are deposited.

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12
Q

What 4 functions does bone allow for?

A

Bone allows for:

  1. Movement (act as levers allowing for movement)
  2. Support (form a frame for the body, allowing us to maintain our shape. The ability of bones to bear weight allows us to stand erect)
  3. Protection (cover and protect vital organs. The skull protects the brain. The rib cage protects the heart and lungs. The spine protects the spinal cord)
  4. Storage (Bones store minerals for use by the body and house bone marrow, which is re- sponsible for the production of blood cells)
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13
Q

Bone Morpho-genetic Proteins (BMP)

A

Family of non-collagenous proteins (signaling molecules that cells use to communicate with each other) in bone that have been found to regulate bone growth.

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14
Q

Cells

A

The workers within the bone

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15
Q

3 Different Bone Cells

A
  1. Osteoblasts - bone building
  2. Osteoclasts - bone destroying
  3. Osteocytes - star shaped cells that reside in cavities within bone. Osteocytes develop from osteoblasts that get trapped in mineralized bone.
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16
Q

2 types of bone marrow

A

Red - found in the interior of flat bones, vertebrae, and in the cancellous bone of the metaphases of long bones.

 - Red blood cells arise her
 - Platelets arise here
 - Most white blood cells arise here

Yellow - found inside the medullary canal of long bones. Yellow bone marrow is differentiated from red bone marrow by it’s HIGHER CONCENTRATION OF FAT CELLS. Some white blood cells arise from yellow bone marrow. Following severe blood loss, yellow bone marrow can convert to red bone marrow to increase the body’s ability to produce blood cells.

17
Q

Stem Cells

A

Cells that can DEVELOP into different kinds of cells. They are IMPORTANT to the body’s ability to CREATE and REPAIR TISSUES.

18
Q

Mesenchymal Stem Cells (MSC)

A

Mesenchymal stem cells (MSC) have the POTENTIAL to DIFFERENTIATE into a VARIETY of cells;

 - Muscle cells
 - Nerve cells
 - Fat cells
 - Osteoblast cells
 - Cartilage cells
19
Q

Hematopoietic Stem Cells (HSC)

A

Hematopoietic Stem Cells (HSC) can differentiate into a variety of IMMUNE CELLS

 - White blood cells
 - Red blood cells
 - Platelets
 - Osteoclasts
20
Q

Endochondral Ossification

A

Bone formation via CARTILAGE INTERMEDIATE (Spine, Pelvis, and Extremities)

21
Q

What are the two mechanisms the body uses to create bone?

A

Endochondral Ossification and Intramembranous Ossification

22
Q

Intramembranous Ossification

A

DIRECT bone formation (Skull, Clavicle and Mandible)

23
Q

Most bony prominences exist to be _______

A

Attachment points for muscles, tendons and ligaments.

24
Q

Osteoblasts lay down a collagen matrix called ____

A

Osteoid

25
Q

Bones increase in height or length through endo chondral ossification at the ________

A

Growth Plates

26
Q

Bones expand in width through ______

A

Intramembranous Ossification.

27
Q

Remodeling

A

The process by which the body continually replaces areas of old necrotic bone with new bone tissue.

It is also the process by which bone is made stronger, or resorbed, as a result of how much the bone is being used

28
Q

Howship’s Lacuna

A

When OSTEOCLASTS make PITS in CANCELLOUS bone in order to REMODEL it.

29
Q

Wolff’s Law

A

Bone is built where stresses require it and resorbed where stresses are absent.

30
Q

Bone repair happens in 3 stages:

A
  1. Inflammation (0-3 weeks)
    - hematoma
  2. Repair (3 was - 4 months)
    - (soft callus, then hard callus)
  3. Remodeling (4 months - 7 years)
31
Q

What is the one important distinction between fracture healing and fusion?

A

The large volume of graft material that eventually needs to be remodeled in fusions.

32
Q

An important additional step in bone remodeling in fusions (vs. fx) is ______

A

The additional step in the REPAIR PHASE that requires blood vessels to grow into the graft in order to supply nutrients and stem cells to that region.

33
Q

To maximize a fusion you should create the following 4 conditions:

A
  1. Bony Apposition - in order for a fusion to occur, the two bones need to be in contact
  2. Maximize Surface Area - The more boney area that is in CONTACT with the ADJACENT bone, the more likely a fusion will occur, and the more STABLE that fusion will be.
  3. Bloody Pathway - Blood VESSELS bring the
    -oxygen
    -nutrients
    -stem cells
    to the area that are needed to build bone
  4. Stable Fixation - EXCESSIVE movement can DISRUPT the formation of bone at the graft site. This can result in a non-union.
34
Q

What are some other factors that can have a negative effect on bone healing?

A
  • Lifestyle
    • Poor Nutrition
    • Tobacco
  • Comorbidities
    • Diabetes
    • Rheumatoid Arthritis
  • Medications
    • Steroids
    • Radiation
    • Cytoxic (chemo) Drugs
35
Q

4 types of bone graft

A

Autograft—Bone relocated from elsewhere in the patient’s body.

Allograft—Bone taken from another member of the same species.

Xenograft—Bone taken from a member of a different species.

Synthetic—These substitutes for bone grafts are created artificially to mimic bone in the body.

36
Q

3 Properties of Bone Graft

A

Osteoconductive—An osteoconductive graft has the ability to provide the framework (scaffold) for new bone growth. An osteoconductive graft satisfies the structural re- quirements for a fusion.

Osteoinductive—An osteoinductive graft has the ability to induce bone growth. An osteoinductive graft satisfies the chemical requirements for a fusion.

Osteogenic—An osteogenic graft has the ability to grow into bone. It contains live bone cells. An osteogenic graft satisfies the biologic requirements for a fusion.

37
Q

Synthetic Grafts include:

A

Calcium Sulfate

38
Q

What are the different circumstances for bone growth,

A
  • INITIAL bone formation in a FETUS
  • GROWTH of the skeleton during CHILDHOOD
  • RENEWAL of the skeleton throughout ADULTHOOD via REMODELING
  • FORMATION BETWEEN bone FRAGMENTS following a FX
  • FUSION of two bones following a CORRECTIVE surgical PROCEDURE

BASIC TRAINING (3 decks)

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