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)
Osteoclasts are multi-nucleated cells
which resorb bone (PTH).

Bone Anatomy

Diaphysis
Metaphysis
Epiphysis Prox/Dist
Epiphyseal line
Periosteum
Compact cortical bone
Spongy bone
Articular Cartilage
Medullary cavity
Marrow
Nutrient artery

Bone Formation:

Key Words:
Mineralization
Intramembranous
Calcification
Endochondral
Ossification
Bone Growth:
Hardness
Tensile strength
Interstitial
Volkmanns canal
Oppositional
Haversian canal
Bone Function:
Lacunae
Mineral homeostasis. Osteon
Trabeculae
Hemopoiesis.

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

Blood Supply to Bone:

Types of Bone tissue:

Woven bone Irregular immature fetus/#
Lamellar bone regular mature.

Circumferential
Concentric
Interstitial
Trabecular

Compact & Spongy - lamellar bone

Enchondral / intramembranous formation.

Compact Bone:

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.

Osteogenic cells:

Bone Remodeling

Vitamin D
Nutrition
Physical activity
Age, hormones
PTH, PHRP
IL1, TNF,TGF-

5-10% bone / year.

Osteoclast in lacuna;

The Histologic Types:

Compact bone
Spongy bone
Lamellar bone
Woven bone
Osteoid
Callus

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.

Compact
Bone
&
Spongy
Bone:

Spongy (cancellous) Bone

Does not contain osteons.
trabeculae surrounding red marrow spaces

Cancellous bone: (Polarization.M)

Endochondral Ossification:

Within cartilage. Interstitial growth. Cells

swell, burst, replace by osteocytes with Ca+

Endochondral Ossification:

Secondary ossification - epiphysis

Articular cartilage and epiphysial plate -

Membranous Ossification:

Skull, mandible, clavicle.

Fibrous membrane, Os. center, trabeculae

Osteoblasts:

Growth plate:

Fractures:

Break in the bone.

Simple / Compound infection.
Single - Horizontal, oblique, spiral,
Comminuted multiple.
Greenstick partial children.
Torus compression of cortex children.

Types of Fracture:

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

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

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

Time after injury

6wk

8wk

Healing in Bone:

Healing in Bone:

Compound Fracture

Fracture Head of Humerus

Immobilization Plaster cast

Bone healing: Callus

Callus Woven bone

Callus Woven bone

Factors affecting Healing:

Systemic & Local factors

Immobilization *
Improper reduction abnormal position
Infection. Debris, dead tissue in wound
Joint involvement

Complications:

Delayed healing.
Non healing.
Joint involvement - ankylosis
Abnormal position arthritis.
Bone necrosis nutrient artery
Involucrum formation.
Pseudoarthrosis

Involucrum

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

If You Fail to Plan,

Then you plan to Fail!