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Bone Healing, Influence of Treatment. Reza Sh. Kamrani M.D. TUMS 2 nd AOTrauma Hand Course Tehran IRAN 20, Apr. 2012. Contents. 1- The importance of the bone healing knowledge 2- Physiology of bone healing 3- Interaction between bone healing and treatment 4- Bone healing in the hand.
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Bone Healing, Influence of Treatment Reza Sh. Kamrani M.D. TUMS 2ndAOTrauma Hand Course Tehran IRAN 20, Apr. 2012
Contents • 1- The importance of the bone healing knowledge • 2- Physiology of bone healing • 3- Interaction between bone healing and treatment • 4- Bone healing in the hand
1- The importance of the bone healing knowledge Bone has a remarkable capacity of healing The result of the treatment depends on the skill of the surgeon in taking the natural healing potential of the tissue Knowledge of bone healing helps the surgeon to better management of the fracture
2010 2004
2- Physiology of bone healing A broken bone heals because... ...it is broken! Mr Alan Apley However it needs a favorable biological and mechanical environment
Bone healing classification; • Enchondral ossification, Callus formation • Direct osteonal healing. Non-callus • Contact healing • Gap healing Natural healing
Callus formation • Stages of healing • 1- hematoma formation • 2- inflammatory response • 3- reparative phase • 4- remodeling • Fx. Healing is said to be complete when repopulation of the marrow space occure (months to years )
Cascade of tissue differentiation following a fracture Hematoma Granulation T. Connective T. Fibrocartilage Mineralized cartilage Bone
Fragment motion Füchtmeyer Callus formation depends on • Motion (direction) • A good blood supply
Stable situation Hente No bone
Necessity of motion Hente 5W Abundant bone 10 cycles per day First stiffness then strength
Too much movement Maintained instability leads to nonunion
Hypertrophic nonunion Arrest of differentiation Good tissues—poor mechanics
Hypertrophic nonunion 0 Weeks Nonunion + Instability
Treatment of hypertrophic nonunion 12 Weeks Nonunion + Stability = Healing
Bone healing classification; • Enchondral ossification, Callus formation • Direct osteonal healing. Non-callus • Contact healing • Gap healing Treatment (stable fixation)
Transitional porosis Lamellar bone formation: 1–2 μm/day
Healing in conditions of absolute stability Remodelling occurs when the bone ends are in contact What happens if a small gap is present?
Stable gap Invasion of blood vesselsand cells
Stable gap Bone deposition No cartilage tissue
Fracture treatment which allows some movement at the fracture site―relative stability―results in healing by callus formation • Callus formation • Resorption of fragment ends • Interfragmentary cartilage
Variables affect on bone healing: • Injury variables • Open fx. • Severity of inj. • Intra-articular fx. • Segmental fx. • Soft tissue interposition • Damage of blood supply
Variables affect on bone healing: • Injury variables • Patient variables • Diseas, Disorders • Age • Nutrition • Systemic hormons • Nicotin
Variables affect on bone healing: • Injury variables • Patient variables • Tissue variables • Type of the bone • Bone necrosis • Bone diseaseC
Variables affect on bone healing: • Injury variables • Patient variables • Tissue variables • Treatment variables • Apposition of the frag. • Loading & Micromotion • Stabilization • Soft tissue management
Variables affect on bone healing: • Injury variables • Patient variables • Tissue variables • Treatment variables • Type of the bone • Bone necrosis • Bone diseaseC
Type of the bone • Bones need rigid fix. • Bones need no fixation
Summary • 1- The importance of the bone healing knowledge • 2- Physiology of bone healing • 3- Interaction between bone healing and treatment • 4- Bone healing in the hand
Summary • Team approach • Bone biology • Implant mechanics • The surgeon • The patient
Bone healing and how it is influenced by treatment I would like to appriciate Dr. Schneider Erich Schneider, CH