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Bone Healing II Flashcards

1
Q

Two types of bone

A

Cortical and cancellous

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2
Q

Two words that describe cortical bone

A

Dense and compact

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3
Q

Cortical bone is most often found in bones that are ______ __________

A

Load bearing

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4
Q

4 words that describe cancellous bone

A

less dense, lattice-like bone

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5
Q

Cancellous bone is not as strong as cortical bone but it is more _________ and may contain _____ ______

A

Vascular, bone marrow

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6
Q

What is cortical bone arranged in units of?

A

Osteons aka haversian systems

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7
Q

Osteonic consist of ______ layers of bone arranged around a central ___________ ___________

A

concentric, haversian canal

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8
Q

What does the haversian canal contain?

A

Blood vessels and nerves

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9
Q

What are interspersed between the concentric layers of bone in the osteons?

A

Osteocytes

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10
Q

What connect the haversian system together?

A

Volkmann’s Canals

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11
Q

Channels that run perpendicular to the haversian canals allowing blood vessels to travel from the outside of the bone to the center

A

Volkmann’s Canals

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12
Q

Cancellous bone consists of interconnected bands of tissue called ______

A

Trabeculae

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13
Q

Thicker trabeculae may contain _______

A

Osteons

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14
Q

Cancellous bone typically contains more irregularly arranged _________

A

Lamellae

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15
Q

Another term for cancellous bone

A

Trabecular bone

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16
Q

Bone building cells

A

Osteoblasts

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17
Q

Bone removing cells

A

Osteoclasts

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18
Q

Cells that reside in cavities within bone and reach through to network with other cells of the same type

A

Osteocytes

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19
Q

These cells within the bone transfer nutrients and wastes and send signals based on stress and strain

A

Osteocytes

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20
Q

Develop from osteoblasts that get trapped in mineralized bone

A

Osteocytes

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21
Q

Line the outer surface of bone

A

Bone lining cells

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22
Q

These cells direct mineral update and release in bone

A

Bone lining cells

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23
Q

Send signals to initiate bone removal and formation

A

Bone lining cells

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24
Q

To create bone, osteoblasts create _______

A

Collagen

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25
Q

Collagen is _____ but has little compressive strength

A

Flexible

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26
Q

What mineral is deposited into collagen?

A

Hydroxyapatite

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27
Q

Hydroxyapatite is ______ but brittle

A

Strong

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28
Q

These two combine to make a material that is both strong and flexible

A

Collagen, hydroxyapatite

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29
Q

Thick fibrous membrane that covers the entire outside surface of the bone except at the joints

A

Periosteum

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30
Q

The periosteum contains blood vessles and nerves as well as _________ _________ which will become osteoblasts

A

Osteoprogenitor cells

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31
Q

A thin layer of tissues that lines the inside surface of bone as well as the hollow space inside the metaphysis of long bones

A

Endosteum

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32
Q

A soft tissue that contains stem cells

A

Bone marrow

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33
Q

The two types of stem cells in bone marrow

A

Mysenchymal and hematopoietic

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34
Q

What 5 things do mysenchymal stem cells create?

A

Cartilage, bone, blood vessel, nerve, and fat cells

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35
Q

What do hemapoietic stem cells create?

A

Blood cells

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36
Q

Where is red bone marrow found?

A

Interior of flat bones, vertebrae, and in cancellous bone in metaphases of long bone

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37
Q

Where is yellow bone marrow found?

A

Inside the medullary canal of long bones

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38
Q

Define remodeling

A

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

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39
Q

Bone remodeling steps

A
  1. Body identifies areas of bone that need replacement
  2. Bone lining cells signal osteoclasts and recruit them
  3. Osteoclasts arrive, attach to bone, create acid environment and create a void
  4. Osteoblasts are recruited after sufficient bone removed
  5. Osteoblasts fill void with osteoid
  6. Osteoid mineralized to become new bone
  7. Some osteoblasts encased in mineralized bone and become osteocytes, others finish filling void and remain outside of the new bone as bone lining cells
40
Q

The remodeling of old necrotic bone or bone grafts

A

Creeping substitution

41
Q

Time it takes to go from resting phase through modeling and back to resting phase

42
Q

During the remodeling phase, the immediate bony area is initially _____________

43
Q

Following the bone remodeling cycle, the mineral density of the region will continue to increase over the next ______ years

44
Q

Bone remodeling and _____ _______ are the same

A

Creeping substitution

45
Q

The term creeping substitution is most commonly used when referring to the incorporation of a ______ ______ into _____ _______

A

Bone graft into living bone

46
Q

To remodel cancellous bone, osteoclasts make pits in the bone named ________ _______

A

Howship’s lacuna

47
Q

After osteoclasts make pits in the bone named Howship’s lacuna, what happens?

A

Osteoblasts then arrive at the site and fill the pit with osteoid which then mineralizes over a period of days to months

48
Q

What do osteoclasts form to remodel cortical bone?

A

A cutting cone that tunnels through bone

49
Q

After the osteoclasts form a cutting cone that tunnels bone, osteoblasts forming concentric rings of ______ to the close the tunnel

50
Q

What forms in the center of the tunnel created by the cutting cone in cortical bone?

A

A blood vessel that forms in the center of the tunnel that then provides osteoblasts to the site (this result is a haversian system)

51
Q

Define Wolff’s Law

A

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

52
Q

When does fracture repair happen?

A

When a bone is broken

53
Q

When does spinal fusion occur?

A

When surgical intervention is needed to stabilize a region

54
Q

What are the three stages of bone repair?

A 
Inflammation Phase (0-3 weeks)
Repair Phase (3 weeks to 4 months)
Remodeling Phase (4 months to 7 years)
55
Q

Blood fills the area around and between the fractured pieces, creating a hematoma. At the same time, immune cells, such as white blood cells, rush to the site leading to inflammation. Osteoclasts are also attracted and begin to remove dead bony tissue. Begins within hours of fracture and continues for 2-3 weeks.

A

Inflammation Phase of Fracture Repair

56
Q

Cells invade the hematoma and begin to lay down fibrous tissue, cartilage and osteod to create a soft callus (3 weeks). The size of the callus is related to the stability of the fracture site. The more stable the fracture, the smaller the callus. The soft callus provides stability to the fracture and is gradually replaced with woven bone (hard callus) through endochondral ossification or intramembranous ossification (3-4 months)

A

Repair Phase of Bone Fracture

57
Q

Once bone unites the fractured fragments, remodeling begins according to Wolff’s law to return the bone to its original shape (up to 7 years)

A

Remodeling Phase of Bone Fracture

58
Q

Difference between fracture healing and fusion

A

In fracture healing, you are taking two bone fragments that were once united and putting them back together

In a fusion, two or more separate individual bones are induced to grow together

59
Q

Bone that is removed from one place and transferred to another

A

Bone graft

60
Q

Three stages of bone graft incorporation

A

Inflammation
Repair
Remodeling

61
Q

Describe the fusion process

A

Initially a hematoma
Soft then hard callus
Callus, along with bone graft, remodeled into living host bone

62
Q

Other differences between fracture and bone healing

A

Bone healing needs large volume of graft

During repair phases, blood vessels must grow into graft to supply nutrients and stell cells to serve that region

63
Q

Lifestyle factors that impact fusion

A 
Poor nutrition
Tobacco
Diabetes
Rheumatoid Arthritis
Steroids
Cytotoxic Drugs
Radiation
64
Q

Bone relocated from elsewhere in the patient’s body

65
Q

Bone taken from another member of the same species

66
Q

Bone taken from a member of a different species

67
Q

Substitute for bone graft artificially created to mimic bone in body

68
Q

Ability to provide framework (scaffold) for new bone growth

A

Osteoconductive

69
Q

Ability to induce bone growth (satisfies chemical requirements for a fusion)

A

Osteinductive

70
Q

Ability to grow into bone (contains live bone cells) and satisfies the biologic requirements for a fusion

A

Osteogenic

71
Q

The gold standard in bone grafting

72
Q

Bone marrow removed surgically from the inside of bones

A

Bone Marrow Aspirate

73
Q

Non-specific grafts (i.e. strut grafts) available in the form of whole or part of bones

A

Base Allograft

74
Q

Grafts designed to be implanted without any modification by the surgeon

A

Machined Grafts

75
Q

Who discovered demineralized bone matrix?

A

Dr. Marshall Urist

76
Q

When the mineral content is removed from allograft, this material remains osteoinductive

A

Demineralized Bone Matrix

77
Q

Usually consists of a power mixed with a carrier that facilitates deliver of the demineralized bone into the surgical site

A

Demineralized Bone Matrix

78
Q

Osteoconductive, Osteoinductive, Osteogenic

79
Q

Osteoconductive

80
Q

Osteoinductive

A

Bone Marrow

81
Q

Demineralized Allograft

A

Osteoconductive, Osteoinductive

82
Q

B-TCP

A

Osteoconductive

83
Q

Hydroxyapatite

A

Osteoconductive

84
Q

BMP

A

Osteoinductive

85
Q

Better known as Plaster of Paris, dissolves in a matter of weeks

A

Calcium Sulfate

86
Q

The OG Synthetic Graft Material

A

Calcium Sulfate

87
Q

A chemical compound consisting of calcium and phosphate

88
Q

Mimics the mineral content of bone

89
Q

A mineral compound consisting of calcium, phosphate, and hydroxyl ions

A

Hydroxapatite

90
Q

Commonly mixed with B-TCP to slow resorption rate of BTCP

A

Hydroxyapatite

91
Q

Polymethyl Metacrylate

92
Q

Polymer used as bone cement

93
Q

Family of proteins found in bone

94
Q

Has the ability to provide the framework (scaffold) for new bone growth (satisfies structural requirements for a fusion)

A

Osteoconductive

95
Q

Has the ability to induce bone growth (satisfies the chemical requirements for a fusion)

A

Osteoinductive

96
Q

Has the ability to grow into bone (satisfies the biologic requirements for a fusion)

A

Osteogenic

Spinal Anatomy (12 decks)

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