* BONE HEALING

PROCESS

Created by :
Citra Wulandari S S.Ked
NPM : 17360093

CLINICAL INTERNSHIP THE SCIENCE OF

ORTHOPAEDIC SURGERY

AT BINTANG AMIN HOSPITAL

YEARS 2018
 * BONE
Two forms of bone tissue
- cortical or compact bone
- cancellous or trabecular bone

two types of bone formation in healing (mechanical and

biological properties)
- woven or immature bone
-lamellar or mature bone
* WOVEN BONE

• More rapid rate of deposition and resorption

• Irregular woven pattern of matrix collage fibril
• Four times the number of osteocyte per unit volume
• Irregular pattern of matrix mineralization

• Less stiff and more easily deformed

* FRACTURE HEALING
Sequence of fracture healing
Inflammation
Repair
Remodeling
 * FRACTURE HEALING INFLAMMATION

Fracture damages the bone, blood vessels, bone matrix and

surounding soft tissue

• Hematoma - dilatation bood vessels

• Inflammatory - plasma exudat
mediator release by - inflammatory cells
platelets - PMN leucocytes
inj.cells - macrophages
- lymphocytes
 * FRACTURE HEALING INFLAMMATION

Macrophage
Degranulating - cytokines (PDGF,TGF β)
Platelets release - interleukin 1&6
- prostaglandin E2 (PGE2)

invitation of the repair process

* FRACTURE HEALING INFLAMMATION

Inflammatory necrosis tissue and exudate resorbed

fibroplasty and condrocytes appears

produce new matrix

(the fracture callus)
 * BONE HEALING REPAIR

 Growth factors
 Fibroblast growth factors angiogenesis
 Osteoclast
 Osteoblast bone formation
 Mesenchymal cell
 Hard callus intramembraneus bone
 Soft callus endochondral ossification
 Fracture callus matrix glycosaminoglycans,proteoglycans, and, collagen
type I and II
Bone healing repair

*Picture
* BONE HEALING REMODELLING

Remodelling
• Replacement of woven bone by lamellar bone
• Resorption of unneeded callus
• Mechanical stability
REMODELLING OF BONE ACCRETION AND REMODELLNG
TRABECULLAR OF BONE

* PICTURE BONE HEALING

REMODELLING
* PICTURE PHASE OF BONE HEALING
 * BONE HEALING

Fracture healing with rigid stabilization

• Healing with primary bone healing mechanism
 Gap healing
 Haversian remodeling

Osteoclast resorb fracture line deposition osteoblast blood

vessels formation
New bone matrix + osteocytes
Form new haversian
Systems or primary osteons
 * BONE HEALING

Variables influence fracture healing

INJURY VARIABLES

• Open fractures
 Impeding or preventing formation & hematoma
 Delaying formation repair tissue
 Risk of infection

• Severity of injury
 Retard fracture healing
* BONE HEALING

INJURY VARIABLES

• Intra articular fractures

if the alignment & congruity joint surface
is not restored
 delayed healing or non union
 joint stiffnes
• segmental fractures
• soft tissue interposition
• Damage to the blood supply
* BONE HEALING

Variables influence fracture healing

Patient varisbles
• Age
• Nutrition
healing process needs
- energy
- proteins & carbohydrates