Anatomy Of Bone

and Fracture
Healing
FUNCTIONS OF BONE

 Forms framework of body,gives form and

shape
 Forms central axis of body
 Supports and transmits body weight
 Protection of vital organs
 Haemopoiesis
 Store-house of calcium and phospate
 Provides lever for locomotion by forming
articulations
 Attachment for muscles and ligaments
Parts Of A Bone

 Epiphysis
 Metaphysis
 Diaphysis
 Periosteum
 Endosteum
Microscopically

 Lamellar
 Mature
 Orderly arrangement of collagen fibres
 Osteon
 Structural unit surrounding a central Haversian Canal
 Volkmann’s Canal – Longitudinally Endosteal to Periosteal
 Woven
 Immature
 Random arrangement of collagen fibres
CLASSIFICATION OF BONE

 According to position
 Axial
 Appendicular
 According to size and shape
 Long bones
 Short bones
 Flat bones
 Irregular bones
 Sesamoid bones
CLASSIFICATION OF BONES

 According to gross structure

 Compact or cortical bone
 Spongy or cancellous bone
 According to development
 Endochondral ossification
 Membranous ossification
Composition

 Bone Cells & Extra-Cellular Matrix

 ECM
 Organic 25%
 Inorganic 65%
 Water 10%
COMPOSITION OF BONE
Cells

 Osteoblasts
 Ossify
 Alkaline Phosphatase
 Osteoclasts
 Resorption
 Acid Phosphatase
 Osteocytes
 Mature Bone Cells
 Glycogen
Growth

 Ossification in centre of shaft

 Primary Ossification
 Secondary
 Ends of Bones
 Apophysis
 Centres that do not contribute longitudinal growth
Blood Supply

 Nutrient Artery

 Metaphyseal

 Epiphyseal

 Periosteal
Principles Of Fracture Healing
Stages

 Haematoma
 <7 days
 Ischaemic Necrosis
 Granulation Tissue
 2-3 weeks
 Daughter Cells
 Callus
 4-12 weeks
 Mineralisation
 Clinically United, Non-Mobile
Stages

 Remodelling
 1-2 years
 Lamellar
 Callus becomes defined
 Modelling
 >3 years
 Indistinguishable from Old
 Weight Bearing
 Stages of fracture healing

 There are 3 major phases with sub divisions:

 A. Reactive phase:
 I. Fracture and inflammatory phase.
 Ii. Stage of hematoma formation.
 Iii. Granulation tissue formation.
 B. Reparative phase:
 Iv. Cartilage callus formation.
 V. Lamellar bone deposition.
 C. Remodeling phase:
 Vi. Remodeling to original bone contour.
 A.Reactive phase

 I .Fracture & inflammatory phase :

After fracture the first change seen by light and
electron microscopy is the presence of blood
cells within the tissues which are adjacent to
the injury site. Soon after fracture, the blood
vessels constrict, stopping any further
bleeding.
 Ii. Stage of hematoma formation:
 Within a few hours after fracture, the extravascular
blood cells form a blood clot, known as
a hematoma. All of the cells within the blood clot
degenerate and die.

 The fracture hematoma immobilizes & splints the

fracture.

 The fracture haematoma provides a fibrin scaffold

that facilitates migration of repair cells.
 Iii. Granulation tissue formation:

 Within this same area, the fibroblasts survive and

replicate. They form a loose aggregate of cells,
interspersed with small blood vessels, known
as granulation tissue which grows forward, outside
and inside the bone to bridge the fracture.

 They are stimulated by vasoactive mediators like

serotonin and histamine.
 B. Reparative phase
 Iv. Cartilage callus formation :

 Days after the # the periosteal cells proximal to

the fracture gap and fibroblasts develop
into chondroblasts which form hyaline cartilage.

 The periosteal cells distal to the fracture gap

develop into osteoblasts which form woven
bone. These 2 tissues unite with their
counterparts and culminate into new mass of
heterogenous tissue called fracture callus
restoring some of its original strength.
 V. Lamellar bone deposition:

 Or consolidation ..Where hyaline cartilage and woven

bone is replaced by lamellar bone. This process is called
endochondral ossification.

 At this point, the mineralized matrix is penetrated by

channels, each containing a microvessel and numerous
osteoblasts.

 This new lamellar bone is in the form of trabecular

bone which restores bone’s original strength.
 C. Remodelling phase
 Vi. Remodelling to original bone contour:

 The remodeling process substitutes the trabecular bone

with compact bone. The trabecular bone is first
resorbed by osteoclasts, creating a shallow resorption
pit known as a "howship's lacuna".

 Then osteoblasts deposit compact bone within the

resorption pit.

 Eventually, the fracture callus is remodelled.

Cancellous Bone healing

 Different

 Only First Two Stages Same

 Uniform Spongy

 No medullary Cavity
Factors

 Age
 Blood Supply
 Co-Morbidities
 Type Of Bone
 Type Of Reduction
 Pattern
 Immobilisation
 Wound
 Compression
Thank You