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Dzikry Kasman

Dzikry Kasman. HISTOMORFOMETRIC ANALYSIS USING IMAGE-J ON FRACTURE HEALING OF BONE WITH MECHANICAL FORCE TO BONE ONLY AND BONE AND PERIOSTEUM ON SPRAGUE- DAWLEY. Introduction. F racture has become a major health problem The incidence vary between 9.0-22.8/1000/year

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Dzikry Kasman

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  1. Dzikry Kasman HISTOMORFOMETRIC ANALYSIS USING IMAGE-J ON FRACTURE HEALING OF BONE WITH MECHANICAL FORCE TO BONE ONLY AND BONE AND PERIOSTEUM ON SPRAGUE- DAWLEY

  2. Introduction • Fracturehas becomea major health problem • The incidence vary between 9.0-22.8/1000/year • In USA there were 11,4 million hospital visit and nearly a million is hospitalized annually; Fracture caused by trauma mostly affected male young adult population. • In 2007 in Indonesia, 8,5% of MVA is asssociated with fracture.; mostly affected patient with productive age (15 – 49 years old). • Int. J. Care Injured (2006) • Rockwood and green fracture in adult. 6th editon. (2006) • Departement Kesehatan Republik Indonesia. (2006) • JBJS (2004)

  3. Fracture also contribute on economic issue • The cost on healthcare service associated with fracture cases : • USA 23,9 billion USD/year • Portugal 7,347 eur/case • Swiss 19.174 eur/case • Productivity Loss Inj Prev 2007 Medscape 2001

  4. Issue in Fracture Healing • The Prevalence of non union and delayed union estimated 2,5-10% • In USA, approximately 5-10% of 6.2 million fracture cases annually Fracture • Injury 2007 • J Medscape 2001 • Int Orthop. 2009

  5. Issue in Fracture Healing • The management more difficult and need more care and funding. • In USA, by preventing delayed and non-union cases, it saved 13.000 USD/ case • Productivity loss and decrease of QoL Fracture Int Orthop. 2009 Bull Hosp Jt Dis. 1997 Cochrane CD006950, 2010

  6. Need a strategy to guard the fracture healing and prevent delayed union or non-union • Need to understand the factors that cause delayed union or non-union

  7. Efforts toaddress the factors that cause delayed union or non union Intervention Model Analysis Method

  8. Fracture Healing Analysis • Radiologic • Computed Tomography (CT) •  Micro CT • Densitometry • Biomechanic • ultimate torque, • torsional stiffness, • Twist to failure, • work to failure. • Histology

  9. Micro CT Expensive Not Widely Available Biomechanic

  10. Histology • Accurate • Dynamicprocess of fracture healing“orchestra” • Quantitative measurement Histomorfometri Need Tools Image J J Bone Miner Res 2005 J Orth Res, 2011 J Orth Res, 2010 http://rsbweb.nih.gov/ij/docs/intro.html

  11. Osteogenic cells Factor in Fracture Healing Diamond Concept Periosteum Osteoconductive scaffold Growth factors Mechanical environment Injury. 2007

  12. Periosteum and Fracture Healing Periosteum consist of : • Outer Layer (fibrous) contain fibroblast, blood vessel and Sharpey • Inner layer (cambium) contain nerve, capillary, osteoblast and mesenchymal stem cell (MSC). Sources of Growth Factor Osteogenic Organ Int. J. Care Injured (2005)

  13. Research Questions • Are there any differences in healing fracture of bone with mechanical force to bone only and bone and periosteum in Sprague-Dawley that were histomor- phometric analyzed using image-j

  14. Hipotesis • There aredifferences in healing fracture of bone with mechanical force to bone only and bone and periosteum in Sprague-Dawleythat were histomor-phometric analyzed using image-j

  15. Aim • To findout comparison of histomorfometric analysis using Image-J of healing fracture of bone with mechanical force to bone only and bone and periosteum in Sprague-Dawley • To createa model of animal research

  16. Theoritical Frame work

  17. Conceptual Frame Work

  18. Research Methods exclusion -disabled -Implant Failure -Infection

  19. Operational Definition

  20. Study Protocol

  21. Operation C B A E D F

  22. Harvesting

  23. Production of Slide D A B E C

  24. RESULT AND DISCUSSION Result • 28 Sprague-Dawley were used. • Body parts are used as experimental material is right femur. • Performed Pathology Anatomy Departement from July to August 2013 • One object was died during experiment • implant failure in 2 object • Histologic process failure in 1 object

  25. Sample Characteristic Body Weight Influence ofbody weight on the results of this study can be ignored. * Shapiro-wilk Test Post Hoc Group A vs Group B p= 0.419 (Mann-Whitney) Group C vs Group D p=0.103 (Independent T-test) Group A vs Group B p= 0.417 (Mann-Whitney) Group C vs Group D p=0.220 (Independent T-test)

  26. Sample Characteristic Histomorfometric

  27. Evaluation of Histomorfometri • Static • 2 weeks • 4 weeks • Dynamic • Control Group • Treatment Group

  28. 2 weeks P= 0,004 P= 0,026 P= 0,001 P < 0,001 * IndependenT test * IndependenT test * IndependenT test * IndependenT test

  29. Discussion • 2 weeks of rat healing fracture: • Increase selularity process, • Formation of cartilage • Cartilage mineralitation begin • Bone formation directly from cells Osteoprogenitorexisting under the periosteum • Mechanical Force to periosteum cause loss of 1/3 of cortical vascular supply • Decrease osteogenic signal • Decrease number of mescencimal stem cell • Mechanical Force to Periosteum conduce • Lower total callus area, osseus area, cartilage area • Higher fibrous area

  30. 4 weeks P= 0,20 P= 0,049 P= 0,001 P= 0,045 * IndependenT test * Mann Whitneytest * IndependenT test * IndependenT test

  31. Discussion • 4 weeks of rat healing fracture: • Peak of mineralitation process  woven and lamelar bone • Mechanical Force to periosteum cause loss of 1/3 of cortical vascular supply • Decrease osteogenic signal • Delayed in mineralitation process • Cartilage area still higher • Lower osseus area • Decrease number of mescencimal stem cell • Lower osseus area • Mechanical Force to Periosteum conduce • Lower total callus area and osseus area • Higher cartilage area and fibrous area

  32. Dynamic Process Fibrous Tissue Area Control Group Trial Group Cartilage Area Control Group Trial Group Osseus Tissue Area Control Group Trial Group

  33. Discussion • There are different dynamic process between control and trial group • Same process with smaller amount • Cartilage area still increase in trial group

  34. Limitation of study • Not fully automated histomorfometric analysis due to single stain only • Only use one length of periosteal stripping (1 cm) • Only use histomorofmetric evaluation, need combination with other modality to see whole picture of healing process.

  35. Conclussion • Mechanical force on periosteum by circularly periosteal stripping 1 cm around fracture site could inhibit healing fracture especially that analyzed histomorphologically by using image-J

  36. Thank you

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