2. Reza Sh. Kamrani M.D. TUMS 2 nd AOTrauma Hand Course Tehran IRAN 20, Apr. 2012

3. 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

4. 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

5. 2004 2010

6. A broken bone heals because......it is broken! Mr Alan Apley However it needs a favorable biological and mechanical environment

7. Bone healing classification; Enchondral ossification, Callus formation Direct osteonal healing. Non-callus Contact healing Gap healing Natural healing

8. 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 )

9. Hematoma Granulation T. Connective T. Fibrocartilage Mineralized cartilage Bone

10. Callus formation depends on Motion (direction) A good blood supply Füchtmeyer

11. Hente No bone

12. Abundant bone 10 cycles per day First stiffness then strength 5W Hente

13. Maintained instability leads to nonunion

14. Arrest of differentiation Good tissues—poor mechanics

15. Nonunion + Instability 0 Weeks

16. Nonunion + Stability = Healing 12 Weeks

17. Bone healing classification; Enchondral ossification, Callus formation Direct osteonal healing. Non-callus Contact healing Gap healing Treatment (stable fixation)

24. Lamellar bone formation: 1–2 μm/day

25. Remodelling occurs when the bone ends are in contact What happens if a small gap is present?

27. Invasion of blood vessels and cells

28. Bone deposition No cartilage tissue

31. Callus formation Resorption of fragment ends Interfragmentary cartilage

33. Variables affect on bone healing:

34. Injury variables Open fx. Severity of inj. Intra-articular fx. Segmental fx. Soft tissue interposition Damage of blood supply

35. Variables affect on bone healing: Injury variables Patient variables Diseas, Disorders Age Nutrition Systemic hormons Nicotin

36. Variables affect on bone healing: Injury variables Patient variables Tissue variables Type of the bone Bone necrosis Bone diseaseC

37. Variables affect on bone healing: Injury variables Patient variables Tissue variables Treatment variables Apposition of the frag. Loading & Micromotion Stabilization Soft tissue management

42. Variables affect on bone healing: Injury variables Patient variables Tissue variables Treatment variables Type of the bone Bone necrosis Bone diseaseC

43. Type of the bone Bones need rigid fix. Bones need no fixation

44. 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

45. Team approach Bone biology Implant mechanics The surgeon The patient

46. AOTrauma Principles Course Bone healing and how it is influenced by treatment Erich Schneider, CH I would like to appriciate Dr. Schneider