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Surgery Lab Quiz > Bone Healing/Grafting > Flashcards

Bone Healing/Grafting Flashcards

1
Q

What are the three long bone blood supply sources in mature animals?

A

Principle nutrient artery
Metaphyseal arteries
Periosteal arteries

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2
Q

What are the long bone blood supply sources in immature animals?

A

Epiphyseal and metaphyseal arteries

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3
Q

What occurs in terms of blood supply with fractured bone?

A

Development of extraosseous blood supply

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4
Q

What are the two types of bone healing?

A

Direct- primary osteonal reconstruction

Indirect- callus formation

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5
Q

When does indirect bone healing (callus formation) occur?

A

Unstable mechanical environment and motion between fracture fragments

  • > 1mm gap between fragments
  • impaired blood supply or revascularization
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6
Q

What are the three stages of indirect bone healing?

A

Inflammation
Repair
Remodeling

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7
Q

When does the inflammation stage of indirect bone healing occur?

A

IMMEDIATELY after fracture, lasts 3-4 days

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8
Q

What occurs in the inflammation stage of indirect bone healing?

A

Clot at fracture site

  • Osteoinductive growth: angiogenesis, bone formation
  • Abundant mast cells: vasoactive substances (new vessel formation)
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9
Q

When does the remodeling phase of indirect bone healing occur?

A

Around 2 months

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10
Q

What occurs during the remodeling phase of indirect bone healing?

A

Clot differentiates into granulation tissue, gain strength, soft callus, mesenchymal cells become osteoblasts (lay down fibrocartilage)

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11
Q

What is the governing law of remodeling?

A

Wolfe’s law
Compression- osteoblasts
Tension- osteoclasts

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12
Q

What is the difference of direct and indirect bone healing?

A

Direct bone healing fills fracture sites with no callus formation

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13
Q

How long does it take to gain mechanical strength?

A

6-12 months

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14
Q

What size are the fracture gaps with direct gap healing?

A

< 1 mm

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15
Q

What size are fracture gaps with direct contact healing?

A

< 0.01 mm

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16
Q

What is contact healing initiated by?

A

Cutting cones of osteclasts directly followed by osteoblasts

17
Q

How far do cones travel per day? (micrometers/day)

A

50-100

18
Q

What are characteristics of cancellous bone healing?

A

More stable than cortical bone
No callus formation
Fracture gap filled then cortical shell

19
Q

Fractured zone of hypertorphy will heal how?

A

Continued growth of physeal cartilage

20
Q

Fractured zone of proliferation will heal how?

A

Endochondral ossification

21
Q

What is a disadvantage to physeal fractures?

A

Premature physeal closure (stunted growth)

22
Q

What are factors that affect fracture healing?

A 
Location of fracture
Stability
Method of fixation
Biological environment
Blood supply
Biomechanical vs. Biological Osteosynthesis
23
Q

What is biological osteosynthesis?

A

Restores overall length and alignment

Limits soft tissue disruption

24
Q

What are the different types of repairs used on fractures?

A

Intermedullary pins with wire
Cast/splints/no fixation
Bone plates
External skeletal fixator

25
Q

Which repairs utilize indirect healing?

A

IM pins/wires
Casts/splints/no fixation
External skeletal fixator

26
Q

What repair heals by direct healing?

A

bone plates

27
Q

What effect does IM pins/nails have on the blood supply?

A

Disrupts endosteal blood supply and medullary blood flow

28
Q

What effect does bone plates have on the blood supply?

A

Disrupt perioseal bone supply

29
Q

What does improper bone implants do to blood supply?

A

damage blood supply

30
Q

When are bone grafts used?

A

Bone loss
Arthrodesis
Delayed/non-union fractures
Old age

31
Q

What are the three bone graft origins?

A

Autograft
Allograft
Xenograft

32
Q

What are the three functions of bone grafts?

A

Osteogenesis (osteoblasts)
Osteoinduction (mesenchymal cells)
Osteoconduction

33
Q

What are the three bone graft types?

A

Cancellous
Cortical
Combination

34
Q

What is the gold standard of bone grafts?

A

Autogenous cancellous bone graft

35
Q

What does Autogenous cancellous bone graft promote?

A

Osteogenesis

36
Q

What are the four phases of cancellous graft?

A

Inflammatino (hours)
Revascularization (1-2 weeks)
Osteoconduction (2-4 weeks)
Mechanical support (up to 12 weeks)

37
Q

Where are autograft cortical bone grafts used?

A

Ribs
ulna
Fibula
Ilial wing

38
Q

What patients are cortical bone grafts indicated in?

A

Devascularized comminuted fractures

OSA patients and limb sparing procedures where dz is caught early and hasn’t metastasized

39
Q

What are the phases of cortical bone graft effects?

A

Osteoclasts move into graft and resorb bone
Osteoblasts follow and lay down new bone
Mechanical strength of graft maintained
Termed “creeping substitution”

Surgery Lab Quiz (11 decks)

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