“Seeing much, suffering much

and studying much are the

three pillars of learning.”
–Benjamin Disraeli
Bone Histology &
Fracture Healing

Dr. Venkatesh M. Shashidhar

Associate Professor of Pathology
Fiji School of Medicine
 Introduction:
• Bone is a dynamic tissue
• Osteoblasts - osteoid (type 1 collagen)
• Calcium and phosphate (calcium
hydroxyapatite)
• Osteoclasts are multi-nucleated cells
which resorb bone (PTH).
Bone Anatomy
• Diaphysis
• Metaphysis
• Epiphysis – Prox/Dist
• Epiphyseal line
• Periosteum
• Compact cortical bone
• Spongy bone
• Articular Cartilage
• Medullary cavity
• Marrow
• Nutrient artery
 Bone Formation: Key Words:
Mineralization
• Intramembranous Calcification
• Endochondral Ossification
Bone Growth: Hardness
•Interstitial Tensile strength
•Oppositional Volkmann’s canal
Haversian canal
Bone Function: Lacunae
• Mineral homeostasis. Osteon
• Hemopoiesis. Trabeculae
An individual at prolonged bed rest
quickly begins to lose bone mineral
density (BMD). Conversely, an
athlete who engages in sports
requiring repetitive jumping and
landing is likely to have a higher
BMD
Blood Supply to Bone:
 Types of Bone tissue:
• Woven bone – Irregular – immature – fetus/#
• Lamellar bone – regular – mature.
– Circumferential
– Concentric
– Interstitial
– Trabecular
• Compact & Spongy - lamellar bone
• Enchondral / intramembranous formation.
Compact Bone:
 The matrix of bone :
• Contains inorganic salt Calcium
Hydroxyapatite in collagen framework.
• Osteoblasts - Calcification - Mineralization
• Minerals  hardness
• Collagen fibres  Tensile strength.
• Collagen is necessary for Calcification.
Osteogenic cells:
 Bone Remodeling
• Vitamin D • 5-10% bone / year.
• Nutrition
• Physical activity
• Age, hormones
• PTH, PHRP
• IL1, TNF,TGF-β
Osteoclast in lacuna;
 The Histologic Types:
• Compact bone
• Spongy bone
• Lamellar bone
• Woven bone
• Osteoid
• Callus
 Compact Bone:
• Osteons or Haversian systems.
• Osteons contain blood vessels, lymphatic
vessels, nerves, and osteocytes along with
the calcified matrix.
• Osteons are aligned in the same direction
along lines of stress - Lamellar bone.
• No osteons or BV in trabecular bone.
Compact
Bone

&

Spongy
Bone:
 Spongy (cancellous) Bone
• Does not contain osteons.
• trabeculae surrounding red marrow spaces
Cancellous bone: (Polarization.M)
 Endochondral Ossification:
• Within cartilage. Interstitial growth. Cells
swell, burst, replace by osteocytes with Ca+
 Endochondral Ossification:
• Secondary ossification - epiphysis
• Articular cartilage and epiphysial plate -
 Membranous Ossification:
• Skull, mandible, clavicle.
• Fibrous membrane, Os. center, trabeculae
Osteoblasts:
Growth plate:
 Fractures:
• Break in the bone.
• Simple / Compound – infection.
• Single - Horizontal, oblique, spiral,
• Comminuted – multiple.
• Greenstick – partial children.
• Torus – compression of cortex – children.
Types of Fracture:
 Healing in Bone:
1D - Hematoma formation (fibrin mesh)
3D - Inflammation – PDGF, IL, TGF
1W - Soft callus – granulation, matrix.
3-6W - Callus – ossification, woven bone
8+W - Re-modeling – absorb/deposit,
strength, lamellate.
Stages of wound healing
Resolution/ Remodeling
Vessel regression, Collagen remodeling

Proliferation
Reepithelialization, Angiogenesis, Fibrogenesis,

Inflammation
PMNs, Macrophages, Lymphocytes

Hemostasis
Fibrin clot, platelet
deposition

Time after injury

Stages of wound healing
Resolution/ Remodeling
Vessel regression, Collagen remodeling

Proliferation
Reepithelialization, Angiogenesis, Fibrogenesis,

Inflammation
PMNs, Macrophages, Lymphocytes

Hemostasis
Fibrin clot, platelet
deposition
1D 3D 1wk 6wk 8wk

Time after injury

Healing in Bone:
Healing in Bone:
Compound Fracture
Fracture Head of Humerus
Immobilization – Plaster cast
Bone healing: Callus
Callus – Woven bone
Callus – Woven bone
 Factors affecting Healing:
• Systemic & Local factors
• Immobilization *
• Improper reduction – abnormal position
• Infection. Debris, dead tissue in wound
• Joint involvement
 Complications:
• Delayed healing.
• Non healing.
• Joint involvement - ankylosis
• Abnormal position – arthritis.
• Bone necrosis – nutrient artery
• Involucrum formation.
• Pseudoarthrosis
Involucrum
 Summary & Further Reading:

• Bone types, histology, formation,

• Osteons, HS, lacunae, lamellae
• Calcium, PO4 ,Vit D, PTH & Calcitonin,
• Healing - stages, factors, complications
• Pseudoarthrosis, involucrum,
• Diseases:
• Osteoporosis, Osteomalacia & Rickets
If You Fail to Plan,
Then you plan to Fail!