SA Ortho - Bone Healing Stable/unstable Flashcards

1
Q

fracture injuries

A

Soft tissue damage
Instability of bone
Loss of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fracture fixation purpose

A

Reestablish mechanic support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does bone depend on to heal

A

Age, location, presence of necrotic debris, vascularity availability, stability, distance between fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stable conditions for bone healing

A

Direct apposition of bone
Direct or primary bone healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Unstable bone healing conditions

A

Connective tissue, fibrocartilage then bone
Indirect or secondary bone healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most important factor in bone healing

A

Vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is stability key in healing?

A

Allows vessels and cells to cross fracture line effectively
Interruptions in this connection from instability regresses progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Distance can cause what in healing

A

If distance is too great the fracture will experience motion and callus will be large as a result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stages of bone healing

A

Coagulation - fracture hematoma
Inflammation - clean up
Granulation - repair
Maturation - remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inflammation

A

Neutrophils
Macrophages
Osteoclasts
Help clean up the area, remove any bacteria present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Granulation

A

More stability = more cartilage
Fibroblasts produce fibrous tissue
Chondrocytes produce fibrocartilage
Osteoblasts produce bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stable conditions - type of callus

A

No gap due to good blood supply - direct or primary healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Unstable conditions - callus type

A

Gap with good blood supply will result in indirect or secondary bone healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Contact areas in primary healing

A

Contact between fragments - gap should be <1mm
GOOD BLOOD SUPPLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Structures in contact area in primary healing

A

Osteoclasts create tunnels across fracture line
Vessels follow
Osteoblasts fill in tunnel in concentric ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What location is NOT ideal for a callus ?

A

Joints ! Not helpful v v bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gap area <200Um

A

Hematoma in gap
Bv and mesenchymal cells
Osteoblasts deposit lamellar bone
Ideal gap space

18
Q

Gap >200uM but <1mm

A

Hematoma in gap
BV and mesenchymal cells
Osteoblasts deposit woven bone haphazard

19
Q

Indirect healing

A

Good blood supply
Large gaps
Not rigidily stable

20
Q

Tissue replacement in indirect bone healing

A

Fibrous tissue first
Fibrocartilage
Bone-woven

21
Q

Features of maturation

A

Remodeling
Modeling
Osteoclasts/blast

22
Q

Direct healing

A

Minimal callus
Takes longer to achieve full bone strength

23
Q

Indirect healing

A

More callus
Remodels faster and stronger but callus may impair

24
Q

Which is better healing for articular fractures

A

Direct - as smooth as possible

25
Factors in describing bone healing
Mechanical Biological Clinical
26
Each factor is scored from 1-10
1=factor does not favor rapid bone healing 10=factor favor bone healing
27
Factors for an assessment scores
Age, health, condition of soft tissue, type of bone (cortical, cancellous) type of injury, open or closed fracture
28
Low scores on fracture assessment
Implants bridge fracture and support all loads Strong durable Plate, external fixator, interlocking nail
29
Mid score fracture assessment
Less implant strength and endurance needed Plates and external fixators, interlocking nail, IM pins and wires
30
High scores on fracture assessment
Bone and implants share load and rapid healing expected External fixator, IM pins and wires, external coaptation
31
Vascularity integrity
32
Fracture location
Metaphyseal heal faster than diaphaseal Distal antebrachium in mini dogs and tibial diaphyseal heal slowwwww
33
Degree of immobilization
More rigid fixation = faster healing
34
Fracture type
More complicated the fracture = slower healing
35
Degree of post-reduction apposition
Better apposition = faster healing
36
Age of animal in healing
Younger = faster
37
Degree of location in healing
Fractures w lots of soft tissue damage - slower healing
38
Degree of bone loss in healing
39
Types of bones involved in healing
Cancellous bone = rapid + rich blood supply Cortical bone = slower (direct healing)
40
Local malignancy in healing
Pathologic fractures can heal just slowly
41
Corticosteroids in healing
Use of corticosteroids will slow healing - inhibit differentiation of osteoblast form mesenchymal cells and decrease rate of synthesis of major components of bone matrix