Wilbur B. Belleca, MD.

, FPOA
 Types
 Normal bone
 lamellar
 Cortical
 Cancellous
 Immature and Pathologic bone
 Woven
 More random with more osteocytes
 Higher turnover
 Weaker and more flexible
 Not stress oriented
 80% of the skeleton
 Tightly packed osteons
 Connected by haversians/ volkmann’s canal
 Interstitial lamellae lies between osteons
 Cement lines define the outer border of an
osteon
 Slow turn over rate
 Relatively high young’s modulus
 Resistance to torsion and bending
 Less dense
 More remodelling (Wolff’s Law)
 Higher turnover rate
 Smaller young’s modulous
 More elastic
 Osteoblast
 Osteoclast
 Osteocytes
 Bone formation
 Derived from undifferentiated mesenchymal
cells
 More ER, golgi apparatus, mitochondria
 Active cells line bone surfaces, less active cells
in resting regiions
 Respond to parathyroid hormone
 Produces ALP, type I collagen, osteocalcin
 Receptor-effector interactions
 PTH
 1,25 dihydroxyvitamin D
 Glucocorticoids
 Prostaglandins
 Estrogen
 Maintain bone
 90% of mature skeleton
 Former osteoblast trapped in newly formed
matrix
 Control of extracellular calcium and
phosphorus
 Stimulated by calcitonin, inhibited by PTH
 Resorb bone
 Multinucleated giant cells from hematopoietic
tissues
 Ruffled (brush) border
 Receptors for calcitonin
 IL1 stimulates activity
 Bisphosphonates inhibits activity
 Lines the haversian canal, endosteum, and
periosteum
 Can differentiate into osteoblast
 Organic components
 40% of dry weight
 Inorganic components
 60% of dry weight
 Collagen
 Type I
 Proteoglycans
 Matrix proteins
 Osteocalcin
 Measure of bone turnover
 Calcium Hydroxyapatite
 Osteoclacium phosphate (brushite)
 Wolff’s law
 Bone remodels according to the mechanical stress
 Significant bone gain with increased mechanical
stress
 Piezoelectric charges
 Compression side, electronegative, osteoblast
activity
 Tension side, electropositive, osteoclast activity
 Cortical bone
 Osteoclastic tunneling (cutting cones) followed by
layering of osteoblast and successive deposition of
layers of lamellae
 Cancellous bone
 Osteoclastic resorption followed by osteoblast laying
down new bones
 5-10% of cardiac output
 Blood supply
 Nutrient artery
 Metaphyseal-epiphyseal
 Periosteal

 Bones with tenuous blood supply

 Scaphoid, talus, femoral head, odontoid
 Bone blood flow is the major determinant of
fracture healing
 Periosteum
 Connective tissue membrane that covers bone
 Thicker in children
 Responsible for growth in diameter
 Bone marrow
 Source of progenitor cells
 Red marrow
 Yellow marrow
 Water (65-80% of wet weight)
 Shifts in and out to allow deformation
 Responsible for nutrition and lubrication
 Increased of water contents leads to increased
permeability, decreased strength, decrease young’s
modulus
 Increase in patients with OA
 Collagen (10-20% wet weight)
 90-95% type II
 Provides tensile strength
 Proteoglycans (10-15% wet weight)
 Provides compressive strength
 Produced by chrondrocytes
 Chondrocytes (5% wet weight)
 Protein synthesis
 Elastohydrodynamic lubrication
 Boundary lubrication
 Boosted lubrication
 Hydrodynamic lubrication
 Weeping lubrication
 Elastohydrodynamic lubrication
 Predominant mechanism during dynamic joint
motion
 Deformation of articular surfaces + thin films of joint
lubricants
 Boundary lubrication
 Slippery surface
 Nondeformable surface
 Primarily a lubricants function
 Boosted lubrication
 Fluid entrapment
 Pools of lubricating fluids trapped by regions of
bearing surface that are making contact
 Higher coefficient of friction

 Hydrodynamic lubrication
 Fluid separates the surfaces under load
 Weeping lubrication
 Fluid shifts to loaded areas
 Chondrocytes become larger, increased
lysosomal enzymes, no longer reproduce
 Increase in stiffness and decrease solubility
 Water content decreases
 Protein content increases
 Deep laceration extending in the tidemark
heals with fibrocartilage
 Suprficial lacerations do not heal
 Continuous passive ROM promotes healing
 Prolonged immobilization leads to atrophy or
degeneration
 Mediates the nutrient exchange between blood
and joint
 Cell types
 A, for phagocytosis
 B, synovial fluid production
 C, intermediate cell type
 Composition
 Hyaluronic acid
 Lubricin (key lubricating component)
 Proteinase
 Collagenase
 Prostaglandins

 Ultrafiltrate of plasma
 Lubricates and provides nourishment through
diffusion