Fracture patterns in different anatomical locations and age demographics: A Cross-sectional Analysis of Microscopic Anatomy.

Till now it was thought that the bone repair and regeneration is controlled by the bone turnover process which is an interplay of bone cells (osteoblasts, osteoclasts and osteocytes), and osteo-inductive growth factors, but recently published review articles observed a major role of immune cells and pro-inflammatory cytokines behind it. These articles also say that the presence of an appropriate immune microenvironment is very important to create an acute inflammatory response which is essential for onset of bone repair and also for late bone remodeling. The bone callus is known to be histologically compatible and non-immunogenic and has osteogenic potential to be used as a graft, but very few studies have practically proven this in humans. These review articles have found that the reason behind slow bone repair and regeneration in elderly is the secretion of senescent markers by the older osteoblasts and osteoclasts, but human studies are required to prove their underlying mechanism. Thus, there is an urgent need to do human research studies to see the structure and function of bone callus with respect to its cellular composition, presence of osteo-inductive growth factors, and the existence of immune micro-environment using histological, immunohistochemistry analyses. No studies have examined the bone callus structure in different age groups, fracture locations and post-fracture times, creating to the need of our study.

The patients with fractures coming to orthopedic OPD, who will fulfil the eligibility criteria will be selected if they give written consent to participate in this project. General information of the patient and the medical/surgical history will be taken using a case record form. The bone callus samples will be collected from the patient during the operation by the orthopedic surgeon who is the co-investigator. The specimen shall be sent to histology laboratory of anatomy department to the principal investigator for staining using the standard histological methods. The stained specimens will be photographed using the trinocular microscope with attached camera and recorded by the principal investigator.      The quantitative data will be compiled in a master chart, tabulated and graphically represented. Later statistical analysis of the data will be done based on the various age groups, fracture sites and fracture period times and conclusions will be derived.