Reza Sh. Kamrani M.D.

TUMS

2nd AOTrauma Hand Course

Tehran IRAN

20, Apr. 2012

1- The importance of the bone healing knowledge

2- Physiology of bone healing3- Interaction between bone healing and

treatment4- Bone healing in the hand

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

2004 2010

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 healingGap healing

Natural healing

Stages of healing

1- hematoma formation2- inflammatory response 3- reparative phase4- remodeling

Fx. Healing is said to be complete when repopulation of the marrow space occure (months to years )

HematomaGranulation T.

Connective T.Fibrocartilage

Mineralized cartilageBone

Callus formation depends on

Motion (direction)

A good blood supply

Füchtmeyer

HenteNo bone

Abundant bone

10 cycles per day

First stiffness then strength

5W

Hente

Maintained instability leads to nonunion

Arrest of differentiation

Good tissues—poor mechanics

Nonunion

+

Instability

0 Weeks

Nonunion

+

Stability

=

Healing

12 Weeks

Bone healing classification;

Enchondral ossification, Callus formation

Direct osteonal healing. Non-callus

Contact healingGap healing

Treatment

(stable fixation)

Lamellar bone formation: 1–2 μm/day

Remodelling occurs when the bone ends are in contact

What happens if a small gap is present?

Invasion of blood vesselsand cells

Bone deposition

No cartilage tissue

• Callus formation

• Resorption of fragment ends

• Interfragmentary cartilage

Variables affect on bone healing:

Variables affect on bone healing:Injury variables Open fx.

Severity of inj.Intra-articular fx.Segmental fx.Soft tissue

interpositionDamage of blood

supply

Variables affect on bone healing:Injury variablesPatient variables Diseas, Disorders

Age NutritionSystemic hormonsNicotin

Variables affect on bone healing:Injury variablesPatient variablesTissue variables Type of the bone

Bone necrosisBone diseaseC

Variables affect on bone healing:Injury variablesPatient variablesTissue variablesTreatment variables Apposition of the

frag.Loading &

MicromotionStabilization Soft tissue

management

Variables affect on bone healing:Injury variablesPatient variablesTissue variablesTreatment variables

Type of the boneBone necrosisBone diseaseC

Type of the boneBones need rigid fix.Bones need no

fixation

1- The importance of the bone healing knowledge

2- Physiology of bone healing3- Interaction between bone healing and

treatment4- Bone healing in the hand

Team approach

Bone biology

Implant mechanics

The surgeon

The patient

AOTrauma Principles Course

Bone healing and how it is influenced by treatment

Erich Schneider, CHI w

ould like to

appriciate Dr. Schneider