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Bone

Healing
Process
Group 7

 Leong Wing Yen  Jovinia
 Vanessa  Sharon
 Yoharena  Nur Fatin

WHAT IS BONE ?

• Bone is essentially a highly vascular, living, constantly
changing mineralized connective tissue which makes up
body’s skeleton.
• Other functions are:
-Bone provides protection for the vital organs of the body
(eg: heart and brain)
-The hematopoietic bone marrow is protected by the
surrounding bony tissue.
- Storage of calcium and phosphate.
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MACROSCOPY  Spongy bone (cancellous) : is composed of a lattice or network of branching bone spicules or trabeculae.  Compact bone (cortical / outer): appears as a mass of bony tissue lacking spaces visible to the unaided eye. 3 . The spaces between the bone spicules contain bone marrow.

such as in initial stage of fracture healing. – Lamellar bone (Mature bone) : Characterized by an orderly cellular distribution and properly oriented collagen fibres . MICROSCOPY – Woven (Immature bone): Characterized by random arrangement of cells and collagen .associated with periods of rapid bone formation. . This constitutes organised bone both cortical and cancellous.

Components of BONE Formation  Cortex  Periosteum  Bone marrow  Soft tissue .

Cell of bone .

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Stages of bone healing .

painful.Inflammation (Hematoma formation) Torn blood vessels hemorrhage A mass of clotted blood (hematoma) forms at the fracture site Site becomes swollen. and inflamed .

 Secretion of TGF-B . myocytes (muscle cells) and adipocytes (fat cells which give rise to marrow adipose tissue). PDGF and various BMP factors (growth factors for bone growth and repair).  Proliferation and Differentiation of mesenchymal stem cells -cells that can differentiate into a variety of cell types eg.Inflammation (Cellular Proliferation)  Within 8 hours inflammatory reaction starts. . osteoblasts (bone cells). chondrocytes (cartilage cells).

Repair (Soft Callus Formation)  Fibrocartilaginous callus forms  Osteoblasts and fibroblasts migrate to the fracture and begin reconstructing the bone  Fibroblasts secrete collagen fibers that connect broken bone ends  Osteoblasts begin forming spongy bone  Osteoblasts furthest from capillaries secrete an externally bulging cartilaginous matrix that later calcifies  Granulation tissue (soft callus) forms a few days after the fracture  Capillaries grow into the tissue and phagocytic cells begin cleaning debris .

and continues until firm union is formed 2- 3 months later . Repair (Hard Callus Formation) New bone trabeculae appear in the fibrocartilaginous callus Fibrocartilaginous callus converts into a bony (hard) callus Bone callus begins 3-4 weeks after injury.

Remodelling Excess material on the bone shaft exterior and in the medullary canal is removed Compact bone is laid down to reconstruct shaft walls .

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Indirect (secondary)bone healing . Direct (primary)bone healing 2.Types of bone healing 1.

Its is the less commonly seen type of healing  Contact healing: When there is direct contact between the cortical bone ends.  Gap healing: When the osteoblast differentiate and start depositing osteoid on the exposed surfaces o fragment ends.5mm are primarily filled with woven bone that is subsequently remodelled into lamellar bone  Larger gaps are healed by indirect bone healing (partially filled with fibrous tissue that undergoes secondary ossification) .  Gaps less than 0. lamellar bones forms directly across the fracture line. Direct (Primary) Direct attempt by the cortex to re-establish itself after interruption without the formation of callus It only works when the edges are touching exactly.

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haemorrhage inflammation .Malunion. Infection . Presences of inter-fragmentary gap . It is comparable to healing of soft tissue by filling of gaps with vascular granulation tissue. Indirect (Secondary) It is usual type consisting of formation of callus either of cartilaginous or fibrous. callus mineralization and callus remodelling. Fibrous union(Non-union). This callus is later replaced by lamellar bone.primary soft callus formation. Involves the classical stages of injury.

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GRANULATION TISSUE AND NEW CAPILLARIES DEVELOP -RESHAPING OF BONE CONTINUE AND GRADUALLY MEDULLARY CANAL IS -OSTEOBLASTS SECRETE SPONGY REOPENED THROUGH THE CALLUS (IN BONE WHICH UNITES THE BROKEN WEEKS/MONTH ) END PRO TECTED BY OUTER LAYER -CALLUS TISSUE COMPLETELY REPLACED OF BONE & CARTILAGE. REPAIR SITE THAN ORIGINALLY. . Summary -DEAD BONE & TISSUE FRAGMENTS -FORMATION OF HAEMATOMA REMOVED BY PHAGOCYTOSIS. WITH MATURE COMPACT BONE & THE -NEW DEPOSITS OF BONE & BONE IS THICKER AND STRONGER AT CARTILAGE IS CALLED CALLUS. BETWEEN THE END OF BONE -FIBROBLASTS MIGRATE TO THE AND SURROUND SOFT TISSUE SITE.

STAGES OF BONE HEALING .