General Ortho Flashcards
What are the 2 glycosaminoglycans?
heparin & keratan sulfate
What are the 2 galactosaminoglycans?
chondroitin & dermatan sulfate
Where are the following located?
- Osteoblasts
- Osteoclasts
- Osteocytes
- Osteoblasts: periosteal/endosteal membrane
- Osteoclasts: cortical bone
- Osteocytes: within bone matrix
What is Howship’s lacunae?
resorption pit made by osteoclasts
Hyaline cartilage is made up of what % of the following?
- water
- collagen
- proteoglycan
- glycoprotein
- chondrocytes
- water = 70%
- collagen = 50%
- proteoglycan = 35%
- glycoprotein = 10%
- chondrocytes = 2-10%
What types of collagen are in articular cartilage?
Type II = 85, 90%
Type XI & Type IX
What type of collagen is in fibrocartilage?
Type I
What are Sharpey’s fibers?
dense band of collagen that merges w/ periosteum – where tendons/ligaments insert on bone
(make up the fibrocartilagenous enthesis)
What is a tidemark?
separates non-mineralized and mineralized regions
Write the steps of muscle contraction
AP release ACh –> sarcolemma –> depolarization (Ca2+ release) –> Ca binds to troponin becomes tropomyosin –> exposes myosin on actin –> myosin engages actin –> uses ATP to slide
Type I/II muscle fibers - white or red? Slow or fast?
Type I = SLOW twitch, lots of O2, RED
Type II = FAST twitch, rich myofibers, WHITE
What are the moments of inertia of pin vs. plate?
pin = pi(r)^4 / 4
plate = b(h)^3 / 12
What is the stress formula?
σ = Force / Area
What is the formula for strain?
Epsilon = Δ L / L 0
- epsilon = strain
- delta L = change in length
- L0 = original length
What is Young’s modulus?
on stress/strain curve, it’s initial linear component slope (stiffness!)
What are 2 layers of periosteum?
- Outer - fibroblastoid
- Inner - cambial layer - osteogenic precursors for bone growth
What is the function of the endocortical envelope?
layer of osteoprogenitor cells that regular Ca2+ exchange
Function of cancellous envelope?
ion and nutrient exchange
Function of intracortical envelope?
osteoprogenitor cells that regulate nutrient exchange between vascular system and extracellular space within cortical bone
List 5 zones of epiphyseal plate and main cell type
- Resting - small oval chondrocytes
- Proliferative - stacked coin chondrocytes
- Hypertrophic - new chondrocytes (bigger) *weakest point, very little matrix
- Calcification - chondroclasts remove dead chondrocytes
- Ossification - osteoblasts make woven bone then osteoclasts change woven to lamellar
What fracture line is created with the following forces?
- compressive
- bending
- torsion
- shear
- compressive = oblique
- bending = transverse/short oblique
- torsion = spiral
- shear = buttress
What strain can this tissue survive?
- Granulation tissue
- Fibrocartilage
- Bone
- GT = up to 100%
- fibrocartilage = 10-15% deformation
- bone = 2%
Do smaller or larger fracture gaps have greater strain potential (with similar loads)?
smaller
With contact healing, what is rate of lamellar bone across fracture?
50-100 micrometer / day
For gap healing, how many weeks to have new cutting cones develop new osteons?
3-4 weeks
List 5 stages of bone healing
- Inflammation
- Intramembranous ossification
- Soft callus formation (chondrogenesis)
- Hard callus formation (endochondral ossification)
- Bone remodeling
During bone healing, is electropositivity on convex or concave surface? Primary cell activity?
Electronegativity?
- Electropositive = CONCAVE = osteoclastic
- Electronegative = CONVEX = osteoblastic
For elastic plate osteosynthesis, how can you generate a more compliant structure?
- implant system with lower moment of inertia (e.g. smaller plate)
- implant system with lower modulus of elasticity
- increasing overall length & functional working length of bone plate
List ways that elastic plate osteosynthesis fails
- plate bending from being overly compliant
- fatigue fx of plate (with short working length)
- fatigue failure +/- screw pull-out (too short plate with short working length)
Described classifications of open fractures according to the Gustilo-Anderson scheme
- Type I = wound <1cm, mild ST contusions (inside out)
- Type II = wound >1cm without extensive ST damage (outside in)
- Type IIIa = adequate ST coverage, extensive damage, high energy trauma
- Type IIIb = extensive tissue loss, periosteal stripping, bone exposure, massive contamination
- Type IIIc = open fx with associated arterial injury that needs repair (+ all above in Type III)
What is the interobserver agreement for Gustilo-Anderson open fx classification scheme?
60%
What are the 5 factors of orthopedic trauma association classification scheme?
- S 1-3 = skin defect
- M 1-3 = muscle injury
- A 1-3 = arterial injury
- B 1-3 = bone loss
- C 1-3 = contamination
What are delayed union/nonunion rates for Type I-III open fractures?
Type I = 0-5%
Type II = 1-14%
Type III = 2-37%
What are the diameter and relative tensile strength of orthopedic wire?
- 16g = 1.2mm; 1.4x
- 18g = 1mm; 1x
- 20g = 0.8mm; 0.64x
- 22g = 0.6mm; 0.36x
- 24g = 0.5mm; 0.25x
For twist knot, how many twists to maintain tension?
1
For a single loop cerclage, how many twists need to be in the loop?
1.5
For twist vs. single loop (SL) vs. double loop (DL), list the loop tension and load resisted before loosening
Twist
- Loop tension = 70.3N
- Load resisted = 268 N
SL
- Tension = 165 N
- Load resisted = 259 N
DL
- Tension = 391 N
- Load resisted = 661 N
What are the principles of cerclage?
- choose size for patient
- length of fx should be 2.5x diameter of bone
- should go around entire circumference
- full contact of bone & wire
- 1.5-3 twists for security
- at least 2 wires used
- not used alone for fixation
- only oblique fractures
- space 1/2 bone diameter apart
- place 1/2 bone diameter from fx line
What makes stronger ILN construct?
- fill 80% medullary cavity
- nail with smaller bolts
- bolts that lock to nail
What are the benefits of an angle-stable nail?
- morse taper screw-cone pegs & shape of holes eliminates slack
- stability with forces from several angles
- hour glass shape (improved area moment of inertia & place lock device with larger diameter)
- smaller deformation
Guidelines for sizes of ILNs?
- 3-4mm = cats/dogs 5-15kg
- 6mm = 15-30kg
- 7mm = up to 40kg
- 8-10mm = > 40kg