Chapter 13 - Bone healing
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1. Pt is present day 15 s/p 5th met fracture. You take XRAYS, what phase of bone healing should you see if pt is healing normally?
Soft callus formation. Starts several days after injury and persists for about 1-2 months. Fibrous and cartilagenous tissue develops at each end of the fracture.
Pt presents 4 months s/p 5th met fracture. If patient is healing normal what phase of bone healing might you visualize on XRAY?
Hard callus formation: if a soft callus is successful in connecting the fracture it begins to ossify. Occurs at around 3-4 months.
Why might it be discouraged to use NSAIDS when fusing a joint? When could pt begin taking NSAIDS if you ask to D/C?
The first stage of bone healing is inflammation. This occures 48 hours and subsides at about 1 week.
Which type of bone healing involves callus formation?
- Secondary (enchondral).
- Primary (membranous) bone healing does not involve callus formation (or little). This occurs when there is good opposition and no motion at the fracture/osteotomy site.
6 months s/p lapidus. XRAYS reveal healing has not advanced at average rate. What is the primary treatment at this point?
At this point it is a delayed union (4-6 months)- the treatment at this point is strict NWB alone.
9 months s/p lapidus. On XRAY all reparative processes of healing have stopped. What is the primary treatment at this point?
- This is a nonunion (8-9 months) - medicare considers a nonunion at 90 days.
- The treatment is bone stimulator or operative means
- Atrophic nonunions usually requre a bone graft
what is it called when a fracture heals in an anatomically incorrect position.
Patient has been using bone stimulator for 2 months but hasn't seen substantial results. Do you have patient d/c BS or continue?
- Continue, BS require approximately 3-6 months for bone healing.
- -You apply electrical current of 5-20 microamprs.
There are three types of bone stimulators. Which requires a surgical procedure in which the cathode is placed into the fracture site?
- Invase BS: the cathode is placed inside and the anode is placed on skin.
- Semi-invasive BS: requires the percutaneous insertion of a cathode into the fracture site.
- Non-invasive: Pulsating Electromagnetic Field (PEMF)
- -uses external apparatus over the fracture site
- - used 10-12 hours/day
- Capacitive coupling
- -place the windows on each side of the fracture
- -used 24 hours/day
What are some contraindications to electrical stimulation?
- synovial pseudarthrosis
- large gap at the fracture site
- -gaps larger than 1/2 diameter of involved bone
- -gaps that are greater than 1 cm apart
Does an allograft have osteoinductive properties?
Does an autograft heal faster than allograft?
- No, only autograft has osteoinductive properties
- Yes an autograft heals faster.
If you had the choice of a bone cortical vs cancellous graft which would you prefer?
- Cancellous graft has the following advantages:
- -many viable cells
- incorporation is faster
- does revascularize
- facilitates osteogenesis
- completely replaced by new bone
- radiodense when healing
- graft becomes stronger each week
*the only advantage I can see of using cortical graft over cancellous is that cortical provides stability (can be fixated).
Where is the best source of cancellous bone?
How do you take a graft from the calcaneous?
- -drill holes to outline a cortical window and cut window with a power saw
- -cortical window is pried from its bed
- -curette out cancellous bone as needed through the window
- -if cortical bone is not needed, replace the window after packing the defect with lyophilized bone
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