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Ifran Saleh Dept.Orthopaedic & Traumatology Faculty of Medicine, Univ.of Indonesia Cipto Mangunkusumo Hospital Jakarta
Bone Histology
Cells in Bone
BONE
Structure & Composition
Bone consists of mesenchymal cells imbedded within abundant extra cellular matrix Bone matrix contains mineral gives tissue great strength & stiffness in compression and bending Organic component primary type I collagen great strength in tension Nerves Lymphatics
BONE
Two forms of bone tissue
Cortical or compact bone Cancellous or trabecular bone Two types of bone (mechanical & biological properties) Woven or immature bone Lamellar or mature bone
WOVEN BONE
More rapid rate of deposition & resorption Irregular woven pattern of matrix collagen fibril Four times the number of osteocyte per unit volume Irregular pattern of matrix mineralization
FRACTURE HEALING
Sequence of fracture healing
-Dilatation blood vessel - Plasma exudat - inflammatory cells Release by - PMN lecocytes platelets inj.cells - Macrophages - Lymphocytes
FRACTURE HEALING
Inflammation
Macrophage Degranulating platelets release
- Cytokines (PDGF, TGF ) - Interleukin 1 & 6 - Prostaglandin E2 (PGE2)
FRACTURE HEALING
INFLAMMATION
Inflammatory Necrosis Tissue and Exudate Resorbed
BONE HEALING REPAIR Growth factors Fibroblast Growth factor Angiogenesis Osteoclast Osteoblast Bone formation Mesenchymal cells Hard callus intramembranous bone Soft callus endochondral ossification Fracture callus matrix glycosaminoglycans, proteoglycans and collagen type I & III
BONE HEALING
REPAIR
Bone Healing
First phase of woven bone formation
Bone Healing
BONE HEALING
Remodelling
Replacement of woven bone by lamellar bone Resorption of unneeded callus mechanical Stability
BONE HEALING
Osteoclast resorb fracture line deposition osteoblast Blood vessels formation He new bone matrix + osteocytes form new Haversian Systems or primary osteons
Bone Healing
BONE HEALING
* Open Fractures
Impeding or preventing formation # Hematoma Delaying formation repair tissue Risk of infection * Severity of Injury Retard fracture healing
BONE HEALING
INJURY VARIABLES
* Intra articular fractures If the alignment & congruity joint surface is not restored Delayed healing or non union Joint stiffness * Segmental fractures * Soft tissue interposition * Damage to the blood supply
BONE HEALING
Variables Influence Fracture Healing
Patient Variables
* Age * Nutrition Healing process needs - Energy - Proteins & carbohydrates
BONE HEALING
Patient variables * Systemic hormones - Corticosteroid ( ) - Growth hormone - Thyroid hormone - Calcitonin - Insulin - Anabolic steroids - DM - Hypervitaminosis D - Rickets * Nicotine
Frame healing
Tissue Variables
* Cancellous or cortical bones * Bone necrosis * Bone disease Pathologic fracture
Osteoprosis Osteomalacia Primary malignant bone tumors Metastatic bone tumors Benign bone tumors Bone cysts Osteogenesis imperfecta Pagets disease Fibrous dysplacia Hyperparathyroidism
* Infection
Treatment Variables
BONE HEALING
Treatment Variables
Fracture stabilization
-Traction - Cast Imm - Ext.Fixation - Int.Fixation
Facilitate fracture healing by Preventing repeated disruption of Repair tissue
Potential disadvantage of int.fixation : Surgical exposure disrupted hematoma, blood supply Risk of infection Rigid fixation alter fracture remodeling, bone density
BONE HEALING
Promote Fracture Healing Bone Grafting Autografts Freezing & Freez drying allografts Bone transport callus distraction Electrical fields Stimulate cell proliferation Promote bone formation Ultra Sound
Aggrecan gene expression Concentration intracellular Ca in callus chondrocyte Demineralized bone matrix, growth factors & antologus bone narrow
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