Bone Healing Updated

Question 1

Two types of bone

Answer 1

Cortical and cancellous

Question 2

Describe cortical bone

Answer 2

Dense and compact

Question 3

Describe cancellous bone

Answer 3

less dense, lattice-like bone

Question 4

What is cortical bone arranged in units of?

Answer 4

Osteons aka haversian systems

Question 5

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

Answer 5

concentric, haversian canal

Question 6

What does the haversian canal contain?

Answer 6

Blood vessels and nerves

Question 7

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

Answer 7

Osteocytes

Question 8

What connect the haversian system together?

Answer 8

Volkmann’s Canals

Question 9

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

Answer 9

Volkmann’s Canals

Question 10

Cancellous bone consists of interconnected bands of tissue called ______

Answer 10

Trabeculae

Question 11

Thicker trabeculae may contain _______

Answer 11

Osteons

Question 12

Cancellous bone typically contains more irregularly arranged _________

Answer 12

Lamellae

Question 13

Another term for cancellous bone

Answer 13

Trabecular bone

Question 14

Bone building cells

Answer 14

Osteoblasts

Question 15

Bone removing cells

Answer 15

Osteoclasts

Question 16

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

Answer 16

Osteocytes

Question 17

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

Answer 17

Osteocytes

Question 18

Develop from osteoblasts that get trapped in mineralized bone

Answer 18

Osteocytes

Question 19

Line the outer surface of bone

Answer 19

Bone lining cells

Question 20

These cells direct mineral update and release in bone

Answer 20

Bone lining cells

Question 21

Send signals to initiate bone removal and formation

Answer 21

Bone lining cells

Question 22

What mineral is deposited into collagen during bone growth?

Answer 22

Hydroxyapatite

Question 23

A soft tissue that contains stem cells

Answer 23

Bone marrow

Question 24

The two types of stem cells in bone marrow

Answer 24

Mysenchymal and hematopoietic

Question 25

What 5 things do mysenchymal stem cells create?

Answer 25

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

Question 26

What do hemapoietic stem cells create?

Answer 26

Blood cells

Question 27

Define remodeling

Answer 27

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

Question 28

Bone remodeling steps

Answer 28

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

Question 29

The remodeling of old necrotic bone or bone grafts

Answer 29

Creeping substitution

Question 30

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

Answer 30

2-3

Question 31

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

Answer 31

Bone graft into living bone

Question 32

Define Wolff's Law

Answer 32

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

Question 33

What are the three stages of bone repair?

Answer 33

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

Question 34

Difference between fracture healing and fusion

Answer 34

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

Question 35

Bone that is removed from one place and transferred to another

Answer 35

Bone graft

Question 36

Three stages of bone graft incorporation

Answer 36

Inflammation Repair Remodeling

Question 37

Lifestyle factors that impact fusion

Answer 37

``` Poor nutrition Tobacco Diabetes Rheumatoid Arthritis Steroids Cytotoxic Drugs Radiation ```

Question 38

Bone relocated from elsewhere in the patient's body

Answer 38

Autograft

Question 39

Bone taken from another member of the same species

Answer 39

Allograft

Question 40

Bone taken from a member of a different species

Answer 40

Xenograft

Question 41

Substitute for bone graft artificially created to mimic bone in body

Answer 41

Synthetic

Question 42

Ability to provide framework (scaffold) for new bone growth

Answer 42

Osteoconductive

Question 43

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

Answer 43

Osteinductive

Question 44

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

Answer 44

Osteogenic

Question 45

The gold standard in bone grafting

Answer 45

Autograft

Question 46

Bone marrow removed surgically from the inside of bones

Answer 46

Bone Marrow Aspirate

Question 47

Grafts designed to be implanted without any modification by the surgeon

Answer 47

Machined Grafts

Question 48

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

Answer 48

Demineralized Bone Matrix

Question 49

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

Answer 49

Demineralized Bone Matrix

Question 50

Demineralized Allograft

Answer 50

Osteoconductive, Osteoinductive

Question 51

B-TCP

Answer 51

Osteoconductive

Question 52

Hydroxyapatite

Answer 52

Osteoconductive

Question 53

BMP

Answer 53

Osteoinductive

Question 54

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

Answer 54

Osteoconductive

Question 55

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

Answer 55

Osteoinductive

Question 56

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

Answer 56

Osteogenic

Question 57

Bone is ___% organic

Answer 57

30%

Question 58

Bone is ___% inorganic

Answer 58

70%

Question 59

Autograft

Answer 59

Osteoconductive, osteoinductive, osteogenic`

Question 60

What are four things a surgeon can do to create a good environment for fusion?

Answer 60

Bony apposition (tight fit on bone graft) Maximize surface area Bloody pathway Stable fixation