8one and CarLllage Peallng

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8one Peallng
Cllnlcal unlon
When fracLure callus becomes sufflclenLly flrm LhaL movemenL
no longer occurs aL Lhe fracLure slLe
W ConsolldaLlon
8adlographlc unlon fracLure llne ()
W 8emodelllng
Peallng bone ls resLored Lo lLs orlglnal shape
sLrucLure and mechanlcal sLrengLh
wolffs low
8one Peallng
octo bolloq lo cooclloos boo
W 9rlnclpally occur Lhrough Lhe formaLlon of an lnLernal
or endosLeal callus
W unlon of fragmenL occurs more rapldly Lhan corLlcal
bone heallng
8lch blood supply Lo Lhe Lhln Lrabeleculae llLLle necrosls
of Lhe bone occurs aL Lhe fracLure surface
arge area of bony conLacL aL Lhe fracLure slLe
unLscher nall
acLors affecLlng Lhe raLe of heallng of fracLures
W 1ype of bone
W 1he paLlenL's age
W MoblllLy aL Lhe fracLure slLe
W SeparaLlon of Lhe bone ends
W lnfecLlon
W ulsLurbance of blood supply
W 9roperLles of Lhe bone lnvlolved
W !olnL lnvolvemenL
W 8one paLhology
W MedlcaLlon
W Co morbldlLles
CarLllage Peallng
W unllke bone carLllage ls exLremely llmlLed ln
lLs ablllLy Lo regeneraLe
W ln an lnLraarLlcular fracLure Lhe hyallne
arLlcular carLllage cannoL be healed by hyallne
carLllage buL only by flbrocarLllage
CarLllage Peallng
W uefecL of arLlcular carLllage LhaL do noL
peneLraLe Lo Lhe subchondral bone fall Lo heal
sponLaneuosly
1hey do noL have acces Lo Lhe progenlLor cells of
Lhe bone marrow space ln Lhe subchondral bone
Cell deaLh near Lhe wound margln
art|a|
1h|ckness
Defect
ChondrocyLe clusLer formaLlon
MaLrlx synLh CaLabollsm
1h|s response |s short ||ved and ||m|ted to repa|r the defect
Intr|ns|c
nea||ng
Avascular uependenL on
nuLrlLlon from slnovlal fluld
CarLllage Peallng
W uefecL LhaL peneLraLe Lo Lhe subchondral
bone ellclL an lnLrlnslc repalr response LhaL
ylelds a flbrocarLolaglnous repalr Llssue wlLh ls
a poor subsLlLuLe for hyallne arLlcular
carLllage
Access Lo Lhe 8M
Mesenchymal sLem cell (+)
||
1h|ckness
Defect
Subchondral ln[ury Cell deaLh
ormaLlon of flbrln cloL
ormaLlon of flbrocarLllaglnous Llssue
- oor sst|tte of hya||n cart||age degenerat|on
- |ght m|croscopy freqent reg|on of d|scont|n|ty
8eplaced by granulaLlon Llssue
Abnormal heallng of Lhe fracLure
W Malunlon
Peal ln Lhe normally expecLed Llme
unsaLlsfacLory poslLlon wlLh resldual bony deformlLy
W uelayed unlon
Peal longer Lhan Lhe normally expecLed Llme
W nonunlon
all compleLely Lo heal wlLh resulLanL formaLlon of elLher a
flbrous unlon or a false [olnL
uelayed unlon
W Peal longer Lhan Lhe normally expecLed Llme
1lbla 20 weeks
Pumerus 10 weeks
emur 20 weeks
W Causes
lnaccuraLe reducLlon
lnadequaLe or lnLerrupLed lmmoblllzaLlon
Severe local LraumaLlzaLlon
lmpalrmenL of bone clrculaLlon
lnfecLlon
oss of bone subsLace
ulsLracLlon or separaLlon of fragmenLs
non unlon
W 1he fracLure ls falled Lo unlLe
W 1wo Lype of non unlon fracLure
PyperLrophlc non unlon
W 8one ends appear scleroLlc
W ulameLer of Lhe fragmenL aL fracLure slLe ls lncreased
W Cood blood supply
ALrophlc non unlon
W 1he bone ends are narrow osLeoporoLlc
W Avascular