II.

BASIC SCIENCES IN ORTHOPAEDICS

BONE HISTOLOGY
Bone
● Highly specialized supporting framework of the body,
characterized by its rigidity, hardness, and power of
regeneration and repair
● Protects the vital organs
● Provides an environment for marrow (both blood forming and ● Trabecular or cancellous bone
fat storage) → Composed of a honeycomb-like network of trabecular plates
● Acts as a mineral reservoir for calcium homeostasis and a and rods interspersed in the bone marrow compartment
reservoir of growth factors and cytokines
● Takes part in acid–base balance

Bone Types
● Based on the pattern of collagen formation of the osteoid

Table 1. Lamellar Bone vs Woven Bone

Lamellar Bone Woven Bone
Normal bone Immature/pathologic
Cortical or cancellous More random
Organized More osteocytes
Strong Increased turnover III. CELLULAR BIOLOGY
Stress-oriented (the more you Weaker / flexible
use it, the stronger it gets) Not stress-oriented
(Destroyed as you use it)

Bone Components

● Osteoblasts
→ Come from mesenchymal stem cells (osteoprogenitor cells)
→ Bone-forming cells
→ Osteoid, hormones, prostaglandins, alkaline phosphatase
(increases in as bone forms, not affected by hormones unlike
● Cortical bone calcium), matrix proteins (bone matrix synthesis to
→ Dense, solid, and surrounds the marrow space mineralization)
▪ Thicker component found outside ● Osteocytes
▪ 80% of skeletal bones → 90% of cells in mature skeleton
▪ Haversian and Volkmann’s (aka perforating) canals → Inactive osteoblasts (terminally differentiated osteoblasts)
trapped in lacunae
→ Have mechanosensors: keeps them away from each other
so they will be equally spaced
→ May undergo apoptosis
● Osteoclasts
Surg 2 Title of Lecture 1 of 4
 → Bone-resorbing cells in Howship’s lacunae ● Bone is formed from connective tissue, such as mesenchyme
→ Monocyte stem-cell lineage tissue, rather than from cartilage
● Osteoprogenitor cells ● Steps
→ Where these cells come from 1. Formation of ossification center
● Lining Cells 2. Calcification
→ No essential function 3. Formation of trabeculae
4. Development of periosteum
Bone Turnover
Endochondral/intercartilagenous ossification

● Greek endon: “within” and chondros: “cartilage”

● Occurs in long bones and most of the rest of the bones in the
body
● It involves an initial hyaline cartilage which continues to grow
MATRIX
● It is also an essential process during the growth of the length of
● Organic components (40%)
long bones and the natural healing of bone fractures
→ Collagen - type 1 collagen (90%)
● Steps:
→ Proteoglycans
1. Development of cartilage model
→ Non-collagenous matrix proteins
2. Growth of cartilage model
→ Growth factors and cytokines
3. Development of the primary ossification center
● Inorganic (mineral) components (60%)
4. Development of the secondary ossification center
→ Calcium hydroxyapatite (99%)
5. Formation of articular cartilage and epiphyseal plate
→ Osteocalcium phosphate (brushite)

OSSIFICATION JOINTS
Intramembranous/mesenchymal ossification Cartilage

● Articular cartilage
● Functions in decreasing friction and in load distribution
● 3A’s: Avascular, aneural, alymphatic
● Composition:
→ Water (65-80%)
→ Collagen (10-20%)
▪ Type II collagen provides tensile strength
→ Proteoglycans (10-15%)
▪ Provides compressive strength
MSC: Mesenchymal stem cells → Chondrocytes (5%)
● One of the two essential processes during fetal development of
the mammalian skeletal system resulting in the formation of bone
tissue
● Mainly occurs during formation of the flat bones of the skull,
mandible, maxilla, and clavicles
● Essential process during the natural healing of bone fractures
and the rudimentary formation of bones of the head

Surg 2 Title of Lecture 2 of 4

 → Fascicles - fibers - myofibrils - sarcomeres - myosin and
actin

Cartilage in Degenerative Osteoarthritis: Incongruent closing of Motor Unit

space in the bone medially ● Composed of:
→ Skeletal muscle
Synovium → Nerves
→ End plate

Table 2. Types of Motor Unit

Type 1 Type 2
● Mediates the exchange of nutrients between blood and joint
 “Slow Red Ox”  Fast Twitch
(synovial) fluid o Slow Twitch  Glycolytic
● Composed of vascularized connective tissue that lacks a o Red  White
basement membrane o Oxidative  For sprinting, fast activities
● Synovial fluid: ultra-filtrate (dialysate) of plasma plus fluid  For resistance, endurance requiring high energy
produced by the synovial membrane activities, marathons,
bicycling
→ Lubricates: Lubricin, key lubricating component
 Decreases in size when not
→ Provides nutrition via diffusion used

Viscosupplementation NERVOUS SYSTEM

● Sodium Hyaluronate ● Composed of:
→ Storage: it absorbs and stores moisture in enormous → Central Nervous System
quantities → Peripheral Nervous System
→ Lubrication
→ Transport medium for nutrients
→ Filter for inflammatory molecules

Meniscus
● Deepens the articular surface of synovial joints, broadens contact
area to distribute the load
● Fibroelastic cartilage: contains both type I and II collagen

IV. NEUROMUSCULAR AND CONNECTIVE TISSUE

SKELETAL MUSCLE ● Nerve Architecture
● Noncontractile elements
→ Muscle body: epimysium, perimysium, endomysium
→ Myotendinous junction: weak link
● Contractile elements
Surg 2 Title of Lecture 3 of 4
 REFERENCES

Resting Potential
● The electrical potential of a neuron or other excitable cell relative
to its surroundings when not stimulated or involved in passage of
an impulse
● At rest, the inside of a neuron is negative relative to the outside
→ Neuron = -70mv
→ Skeletal muscle cell = -90mv
→ Epithelial cell = -50mv

Action Potential
● The change in electrical potential associated with the passage of
an impulse along the membrane of a muscle cell or nerve cell

CONNECTIVE TISSUE
● Tendons
→ Connection between muscles and bones
● Ligaments
→ Connection between bones forming a joint
● Intervertebral discs
→ Ligaments that lie between adjacent vertebrae in the spine
which form a fibrocartilaginous joint to allow slight movement
of the vertebrae

Surg 2 Title of Lecture 4 of 4