Bone Healing II Flashcards
(96 cards)
1
Q
Two types of bone
A
Cortical and cancellous
2
Q
Two words that describe cortical bone
A
Dense and compact
3
Q
Cortical bone is most often found in bones that are ______ __________
A
Load bearing
4
Q
4 words that describe cancellous bone
A
less dense, lattice-like bone
5
Q
Cancellous bone is not as strong as cortical bone but it is more _________ and may contain _____ ______
A
Vascular, bone marrow
6
Q
What is cortical bone arranged in units of?
A
Osteons aka haversian systems
7
Q
Osteonic consist of ______ layers of bone arranged around a central ___________ ___________
A
concentric, haversian canal
8
Q
What does the haversian canal contain?
A
Blood vessels and nerves
9
Q
What are interspersed between the concentric layers of bone in the osteons?
A
Osteocytes
10
Q
What connect the haversian system together?
A
Volkmann’s Canals
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
12
Q
Cancellous bone consists of interconnected bands of tissue called ______
A
Trabeculae
13
Q
Thicker trabeculae may contain _______
A
Osteons
14
Q
Cancellous bone typically contains more irregularly arranged _________
A
Lamellae
15
Q
Another term for cancellous bone
A
Trabecular bone
16
Q
Bone building cells
A
Osteoblasts
17
Q
Bone removing cells
A
Osteoclasts
18
Q
Cells that reside in cavities within bone and reach through to network with other cells of the same type
A
Osteocytes
19
Q
These cells within the bone transfer nutrients and wastes and send signals based on stress and strain
A
Osteocytes
20
Q
Develop from osteoblasts that get trapped in mineralized bone
A
Osteocytes
21
Q
Line the outer surface of bone
A
Bone lining cells
22
Q
These cells direct mineral update and release in bone
A
Bone lining cells
23
Q
Send signals to initiate bone removal and formation
A
Bone lining cells
24
Q
To create bone, osteoblasts create _______
A
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
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Poor nutrition
Tobacco
Diabetes
Rheumatoid Arthritis
Steroids
Cytotoxic Drugs
Radiation
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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
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Ability to induce bone growth (satisfies chemical requirements for a fusion)
Osteinductive
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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
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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
