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“Seeing much, suffering much and studying much are the three pillars of learning.” –Benjamin Disraeli. Bone Histology & Fracture Healing. Introduction:. Bone is a dynamic tissue Osteoblasts - osteoid (type 1 collagen) Calcium and phosphate (calcium hydroxyapatite)

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Bone Histology & Fracture Healing


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    1. “Seeing much, suffering much and studying much are the three pillars of learning.”–Benjamin Disraeli

    2. Bone Histology & Fracture Healing

    3. Introduction: • Bone is a dynamic tissue • Osteoblasts - osteoid (type 1 collagen) • Calcium and phosphate (calcium hydroxyapatite) • Osteoclasts are multi-nucleated cells which resorb bone (PTH).

    4. Bone Anatomy • Diaphysis • Metaphysis • Epiphysis – Prox/Dist • Epiphyseal line • Periosteum • Compact cortical bone • Spongy bone • Articular Cartilage • Medullary cavity • Marrow • Nutrient artery

    5. Bone Formation: Key Words: Mineralization Calcification Ossification Hardness Tensile strength Volkmann’s canal Haversian canal Lacunae Osteon Trabeculae • Intramembranous • Endochondral Bone Growth: • Interstitial • Oppositional Bone Function: • Mineral homeostasis. • Hemopoiesis.

    6. An individual at prolonged bed rest quickly begins to lose bone mineral density (BMD). Conversely, an athlete who engages in sports requiring repetitive jumping and landing is likely to have a higher BMD

    7. Blood Supply to Bone:

    8. Types of Bone tissue: • Woven bone – Irregular – immature – fetus/# • Lamellar bone – regular – mature. • Circumferential • Concentric • Interstitial • Trabecular • Compact & Spongy - lamellar bone • Enchondral / intramembranous formation.

    9. Compact Bone:

    10. The matrix of bone : • Contains inorganic salt Calcium Hydroxyapatite in collagen framework. • Osteoblasts - Calcification - Mineralization • Minerals  hardness • Collagen fibres  Tensile strength. • Collagen is necessary for Calcification.

    11. Osteogenic cells:

    12. Vitamin D Nutrition Physical activity Age, hormones PTH, PHRP IL1, TNF,TGF-β 5-10% bone / year. Bone Remodeling

    13. Osteoclast in lacuna;

    14. The Histologic Types: • Compact bone • Spongy bone • Lamellar bone • Woven bone • Osteoid • Callus

    15. Compact Bone: • Osteons or Haversian systems. • Osteons contain blood vessels, lymphatic vessels, nerves, and osteocytes along with the calcified matrix. • Osteons are aligned in the same direction along lines of stress - Lamellar bone. • No osteons or BV in trabecular bone.

    16. Compact Bone&Spongy Bone:

    17. Spongy (cancellous) Bone • Does not contain osteons. • trabeculae surrounding red marrow spaces

    18. Cancellous bone: (Polarization.M)

    19. Endochondral Ossification: • Within cartilage. Interstitial growth. Cells swell, burst, replace by osteocytes with Ca+

    20. Endochondral Ossification: • Secondary ossification - epiphysis • Articular cartilage and epiphysial plate -

    21. Membranous Ossification: • Skull, mandible, clavicle. • Fibrous membrane, Os. center, trabeculae

    22. Osteoblasts:

    23. Growth plate:

    24. Fractures: • Break in the bone. • Simple / Compound – infection. • Single - Horizontal, oblique, spiral, • Comminuted – multiple. • Greenstick – partial children. • Torus – compression of cortex – children.

    25. Types of Fracture:

    26. Healing in Bone: 1D - Hematoma formation (fibrin mesh) 3D - Inflammation – PDGF, IL, TGF 1W - Softcallus – granulation, matrix. 3-6W - Callus – ossification, woven bone 8+W -Re-modeling – absorb/deposit, strength, lamellate.

    27. Stages of wound healing Resolution/ Remodeling Vessel regression, Collagen remodeling Proliferation Reepithelialization, Angiogenesis, Fibrogenesis, Inflammation PMNs, Macrophages, Lymphocytes Hemostasis Fibrin clot, platelet deposition Time after injury

    28. Stages of wound healing Resolution/ Remodeling Vessel regression, Collagen remodeling Proliferation Reepithelialization, Angiogenesis, Fibrogenesis, Inflammation PMNs, Macrophages, Lymphocytes Hemostasis Fibrin clot, platelet deposition 1D 3D 1wk 6wk 8wk Time after injury

    29. Healing in Bone:

    30. Healing in Bone:

    31. Compound Fracture

    32. Fracture Head of Humerus

    33. Immobilization – Plaster cast

    34. Bone healing: Callus

    35. Callus – Woven bone

    36. Callus – Woven bone

    37. Factors affecting Healing: • Systemic & Local factors • Immobilization * • Improper reduction – abnormal position • Infection. Debris, dead tissue in wound • Joint involvement

    38. Complications: • Delayed healing. • Non healing. • Joint involvement - ankylosis • Abnormal position – arthritis. • Bone necrosis – nutrient artery • Involucrum formation. • Pseudoarthrosis

    39. Involucrum

    40. Summary & Further Reading: • Bone types, histology, formation, • Osteons, HS, lacunae, lamellae • Calcium, PO4 ,Vit D, PTH & Calcitonin, • Healing - stages, factors, complications • Pseudoarthrosis, involucrum, • Diseases: • Osteoporosis, Osteomalacia & Rickets

    41. If You Fail to Plan, Then you plan to Fail!