BONE HEALING<br />Ketan D Deshpande<br />Dept. of Orthopedics<br />ESIPGIMSR MGM Hospital<br />
Bone Histology<br />Cells in Bone<br />
Bone Histology<br />Periosteum & Endosteum<br />
BONE<br />Two forms of bone tissue<br /><ul><li> Cortical or compact bone
 Cancellous or trabecular bone</li></ul>Two types of bone formation in healing<br />(mechanical & biological properties)<b...
 Lamellar or mature bone</li></li></ul><li>WOVEN BONE<br /><ul><li> 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 </li></ul>Less stiff & more easily deformed<br />
FRACTURE HEALING<br />Sequence of fracture healing<br /><ul><li> Inflammation
 Repair
 Remodeling </li></li></ul><li>Fracture Healing<br />Inflammation<br />Fracture          damages the bone, blood vessels, ...
 Plasma exudat
 inflammatory cells
 PMN lecocytes
 Macrophages
 Lymphocytes
 Haematoma
 Inflammatory </li></ul>    mediators           <br />Release by<br />platelets inj.cells<br />
FRACTURE HEALING<br />Inflammation<br />Macrophage<br />Degranulating <br />platelets release<br /><ul><li> Cytokines (PDG...
 Interleukin 1 & 6
 Prostaglandin E2 (PGE2)</li></ul>Invitiation of the repair process<br />
FRACTURE HEALING<br />INFLAMMATION<br />Inflammatory         Necrosis Tissue and Exudate Resorbed<br />Fibroplasty & Chond...
BONE HEALING<br />REPAIR<br /><ul><li> Growth factors
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Bone healing

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Dr. Ketan Deshpande
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Published in: Health & Medicine, Spiritual

Bone healing

  1. 1. BONE HEALING<br />Ketan D Deshpande<br />Dept. of Orthopedics<br />ESIPGIMSR MGM Hospital<br />
  2. 2. Bone Histology<br />Cells in Bone<br />
  3. 3. Bone Histology<br />Periosteum & Endosteum<br />
  4. 4. BONE<br />Two forms of bone tissue<br /><ul><li> Cortical or compact bone
  5. 5. Cancellous or trabecular bone</li></ul>Two types of bone formation in healing<br />(mechanical & biological properties)<br /><ul><li> Woven or immature bone
  6. 6. Lamellar or mature bone</li></li></ul><li>WOVEN BONE<br /><ul><li> More rapid rate of deposition & resorption
  7. 7. Irregular woven pattern of matrix collagen fibril
  8. 8. Four times the number of osteocyte per unit volume
  9. 9. Irregular pattern of matrix mineralization </li></ul>Less stiff & more easily deformed<br />
  10. 10. FRACTURE HEALING<br />Sequence of fracture healing<br /><ul><li> Inflammation
  11. 11. Repair
  12. 12. Remodeling </li></li></ul><li>Fracture Healing<br />Inflammation<br />Fracture damages the bone, blood vessels, <br />bone matrix and surrounding soft tissue<br /><ul><li>Dilatation blood vessel
  13. 13. Plasma exudat
  14. 14. inflammatory cells
  15. 15. PMN lecocytes
  16. 16. Macrophages
  17. 17. Lymphocytes
  18. 18. Haematoma
  19. 19. Inflammatory </li></ul> mediators <br />Release by<br />platelets inj.cells<br />
  20. 20. FRACTURE HEALING<br />Inflammation<br />Macrophage<br />Degranulating <br />platelets release<br /><ul><li> Cytokines (PDGF, TGF ß )
  21. 21. Interleukin 1 & 6
  22. 22. Prostaglandin E2 (PGE2)</li></ul>Invitiation of the repair process<br />
  23. 23. FRACTURE HEALING<br />INFLAMMATION<br />Inflammatory Necrosis Tissue and Exudate Resorbed<br />Fibroplasty & Chondrocytes Appears<br />Produce new matrix<br />(The fracture callus)<br />
  24. 24. BONE HEALING<br />REPAIR<br /><ul><li> Growth factors
  25. 25. Fibroblast Growth factor Angiogenesis
  26. 26. Osteoclast
  27. 27. Osteoblast Bone formation
  28. 28. Mesenchymal cells
  29. 29. Hard callus intramembranous bone
  30. 30. Soft callus endochondral ossification
  31. 31. Fracture callus matrix glycosaminoglycans,</li></ul> proteoglycans and collagen type I & III<br />
  32. 32. BONE HEALING<br />REPAIR<br />
  33. 33. Bone Healing<br />First phase of woven bone formation<br />Later phase in woven bone formation <br />
  34. 34. Bone Healing<br />Chronology of mineralization in subchondral bone<br />
  35. 35. BONE HEALING<br />Remodelling<br /><ul><li> Replacement of woven bone </li></ul> by lamellar bone<br /><ul><li> Resorption of unneeded callus
  36. 36. mechanical Stability </li></li></ul><li>BONE HEALING<br />REMODELING<br />Remodeling of bone trabecula<br />Accretion and remodeling of bone<br />
  37. 37. BONE HEALING<br />
  38. 38. BONE HEALING<br />Fracture healing with rigid stabilization<br />* Healing with primary bone healing mechanism<br /><ul><li> Gap healing
  39. 39. Haversian remodeling</li></ul>Osteoclast resorb fracture line deposition osteoblast<br />Blood vessels formation<br /> new bone matrix + osteocytes <br />form new Haversian<br />Systems or primary osteons<br />
  40. 40. Bone Healing<br />Direct bone formation <br />in stabilized gap bone<br />Courtesy AO Risert laboratory<br />
  41. 41. BONE HEALING<br />Variables Influence Fracture Healing<br />INJURY VARIABLES<br />* Open Fractures<br /><ul><li> Impeding or preventing formation # Hematoma
  42. 42. Delaying formation repair tissue
  43. 43. Risk of infection</li></ul>* Severity of Injury<br /><ul><li> Retard fracture healing</li></li></ul><li>BONE HEALING<br />INJURY VARIABLES<br />* Intra articular fractures<br />If the alignment & congruity joint surface <br />is not restored<br /><ul><li> Delayed healing or non union
  44. 44. Joint stiffness</li></ul>* Segmental fractures<br />* Soft tissue interposition<br />* Damage to the blood supply<br />
  45. 45. BONE HEALING<br />Variables Influence Fracture Healing<br />Patient Variables<br />* Age<br />* Nutrition<br />Healing process needs<br /><ul><li> Energy
  46. 46. Proteins & carbohydrates</li></li></ul><li>WOLFF’s LawThe principle that every change in the form and the Function of a bone or in the Function of the Bone alone leads to changes in its Internal Architecture and in its External Form<br />
  47. 47.
  48. 48. T H A N K Y O U !<br />
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