Bone Healing II Flashcards Preview

Spinal Anatomy > Bone Healing II > Flashcards

Flashcards in Bone Healing II Deck (96):
1

Two types of bone

Cortical and cancellous

2

Two words that describe cortical bone

Dense and compact

3

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

Load bearing

4

4 words that describe cancellous bone

less dense, lattice-like bone

5

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

Vascular, bone marrow

6

What is cortical bone arranged in units of?

Osteons aka haversian systems

7

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

concentric, haversian canal

8

What does the haversian canal contain?

Blood vessels and nerves

9

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

Osteocytes

10

What connect the haversian system together?

Volkmann's Canals

11

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

Volkmann's Canals

12

Cancellous bone consists of interconnected bands of tissue called ______

Trabeculae

13

Thicker trabeculae may contain _______

Osteons

14

Cancellous bone typically contains more irregularly arranged _________

Lamellae

15

Another term for cancellous bone

Trabecular bone

16

Bone building cells

Osteoblasts

17

Bone removing cells

Osteoclasts

18

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

Osteocytes

19

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

Osteocytes

20

Develop from osteoblasts that get trapped in mineralized bone

Osteocytes

21

Line the outer surface of bone

Bone lining cells

22

These cells direct mineral update and release in bone

Bone lining cells

23

Send signals to initiate bone removal and formation

Bone lining cells

24

To create bone, osteoblasts create _______

Collagen

25

Collagen is _____ but has little compressive strength

Flexible

26

What mineral is deposited into collagen?

Hydroxyapatite

27

Hydroxyapatite is ______ but brittle

Strong

28

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

Collagen, hydroxyapatite

29

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

Periosteum

30

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

Osteoprogenitor cells

31

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

Endosteum

32

A soft tissue that contains stem cells

Bone marrow

33

The two types of stem cells in bone marrow

Mysenchymal and hematopoietic

34

What 5 things do mysenchymal stem cells create?

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

35

What do hemapoietic stem cells create?

Blood cells

36

Where is red bone marrow found?

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

37

Where is yellow bone marrow found?

Inside the medullary canal of long bones

38

Define remodeling

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

39

Bone remodeling steps

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

The remodeling of old necrotic bone or bone grafts

Creeping substitution

41

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

6 months

42

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

Weakened

43

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

2-3

44

Bone remodeling and _____ _______ are the same

Creeping substitution

45

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

Bone graft into living bone

46

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

Howship's lacuna

47

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

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

48

What do osteoclasts form to remodel cortical bone?

A cutting cone that tunnels through bone

49

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

Osteoid

50

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

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

Define Wolff's Law

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

52

When does fracture repair happen?

When a bone is broken

53

When does spinal fusion occur?

When surgical intervention is needed to stabilize a region

54

What are the three stages of bone repair?

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

55

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.

Inflammation Phase of Fracture Repair

56

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)

Repair Phase of Bone Fracture

57

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)

Remodeling Phase of Bone Fracture

58

Difference between fracture healing and fusion

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

Bone that is removed from one place and transferred to another

Bone graft

60

Three stages of bone graft incorporation

Inflammation
Repair
Remodeling

61

Describe the fusion process

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

62

Other differences between fracture and bone healing

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

Lifestyle factors that impact fusion

Poor nutrition
Tobacco
Diabetes
Rheumatoid Arthritis
Steroids
Cytotoxic Drugs
Radiation

64

Bone relocated from elsewhere in the patient's body

Autograft

65

Bone taken from another member of the same species

Allograft

66

Bone taken from a member of a different species

Xenograft

67

Substitute for bone graft artificially created to mimic bone in body

Synthetic

68

Ability to provide framework (scaffold) for new bone growth

Osteoconductive

69

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

Osteinductive

70

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

Osteogenic

71

The gold standard in bone grafting

Autograft

72

Bone marrow removed surgically from the inside of bones

Bone Marrow Aspirate

73

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

Base Allograft

74

Grafts designed to be implanted without any modification by the surgeon

Machined Grafts

75

Who discovered demineralized bone matrix?

Dr. Marshall Urist

76

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

Demineralized Bone Matrix

77

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

Demineralized Bone Matrix

78

Osteoconductive, Osteoinductive, Osteogenic

Autograft

79

Osteoconductive

Allograft

80

Osteoinductive

Bone Marrow

81

Demineralized Allograft

Osteoconductive, Osteoinductive

82

B-TCP

Osteoconductive

83

Hydroxyapatite

Osteoconductive

84

BMP

Osteoinductive

85

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

Calcium Sulfate

86

The OG Synthetic Graft Material

Calcium Sulfate

87

A chemical compound consisting of calcium and phosphate

B-TCP

88

Mimics the mineral content of bone

B-TCP

89

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

Hydroxapatite

90

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

Hydroxyapatite

91

Polymethyl Metacrylate

PMMA

92

Polymer used as bone cement

PMMA

93

Family of proteins found in bone

BMP

94

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

Osteoconductive

95

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

Osteoinductive

96

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

Osteogenic