The osteon consists of a central canal called the osteogenic (Haversian) canal, which is surrounded by concentric rings (lamellae) of the matrix. The bone retains its original structure and mechanical characteristics. Please talk to your doctor and ask it is wiser to investigate further or okay to wait and watch. Trabecular or cancellous bone is found predominantly at the ends of long bones and inner parts of flat bones and is composed of interconnecting plates and bars within which lies the bone marrow. The cortical bone encrircling each slice was trimmed off with a cleaver, leaving intact a lacy slice of trabecular bone. Cortical bone forms the external layer of all bones but is found predominantly in the appendicular skeleton, particularly in diaphysis of long bones. It surrounds by an extracellular matrix composed of calcium and phosphorous-rich hydroxyapatite. The material properties measured can differ depending on the measuring techniques (Rho et al., 1993). Cortical bone structure and trabecular volumetric bone mineral density (vBMD) are commonly evaluated using peripheral quantitative computed tomography (pQCT). Their unique composition and design allows bones to be relatively hard and strong, while remaining lightweight. You can follow him on Facebook, Linkedin and Twitter. It is also present in limited amounts in the juxtaarticular extremities of appendicular skeleton. I do recall him saying possibly osteomalasia? McGrath and Watson used cortical grafts from the distal radius with a size of 3 × 1 cm and several cubic centimeters of cancellous bone. Scaphoid fractures account for up to 15% of acute wrist injuries and 50% to 80% of carpal fractures. The concern should arise if the difference is focal rather than widespread. If there is an MRI finding that bothers, review of the image from radiologist can be asked. This can be problematic, for example, when there is a dense cortical layer of bone formed within the alveolar process of a previously (long-ago) extracted tooth. The mechanical properties of cortical bone progressively deteriorate with aging for both men and women (Burr, 1997; Burstein et al., 1976). Cortical bone is a dense tissue that contains less than 10% soft tissue. Woven bone is again distinguished by the fact that no discernible entities exist at the second structural … In the adult skeleton, activation occurs about every 10 seconds. In adults, approximately 80% of trabecular and approximately 95% of intracortical bone surfaces are inactive with respect to bone remodeling [64,65]. Changes in the color of burnt bones can provide information on their recovery, trauma history, structural changes, DNA degradation, and the temperature to which they were exposed [2,3]. Advantages of nonvascularized grafts are easy harvest and availability with a low complication rate at the donor site. The Haversian systems are packed tightly together to form what appears to be a solid mass. A disadvantage is the slower process of revascularization and remodeling. Furthermore, cortical bone can be classified as a relatively ductile material for longitudinal loading since its ultimate strain for longitudinal loading is substantially larger than its yield strain. X Ray was questionable so they ordered an MRI. In summary, two hypotheses are addressed in this study: trabecular bone and cortical bone share the same regulatory mechanisms for adaptation to mechanical loads, and the development of cortical bone is gov-erned by mechanical stimuli. At nano-scale dimensions, bone is composed of type-I mineralized Heat exposure induced water and organic material evaporations as well as contraction of bone tissues and changed the structure, shape, and color of them [1]. Two fibrovascular layers surround the cortical bone which contain cells that remain osteogenic. The canaliculi connect to the adjacent cavities, instead of a central Haversian canal, to receive their blood supply. Cortical bone refers to the thick outer surface of typically a long bone [for example humerus or femur shaft] that ensheathes the cavity of the bone called medulla. These lining cells have receptors for a variety of substances, which are important for initiating bone resorption (PTH, PGE2), and may respond to such substances by resorbing this surface osteoid, which is covering the bone. The rate of union was higher for iliac crest bone (73%) than for radial bone (47%). Cortical bone is mainly formed beneath the periosteum and is mainly resorbed at what has become the endosteum, so that diaphysial cortical bone represents a by-product of growth in width [7,8]. This study was partially supported by the Research Project of the Research Institute of Personalized Health Sciences, Health Sciences University of Hokkaido. As such, the basic multicellular unit (BMU) consists of a group of cells that participate in remodeling in a concerted and coordinated fashion. Autologous bone provides mechanical support to the vessels and cellular elements that colonize the grafting site; it stimulates bone formation at the graft site; and it contains mature cellular elements that can directly create new bone. Cortical or compact bone forms approximately 90% of the skeleton and is found mainly in the shafts of long bones and surfaces of flat bones. Cancellous bone grafts consist predominantly of trabecular bone tissue. Cortical bone forms the external layer of all bones but is found predominantly in the appendicular skeleton, particularly in diaphysis of long bones. The wrist joint is a diarthrodial joint composed of two rows of carpal bones. The three characteristic stages of creep behavior as described in many conventional engineering materials are also observed in cortical bone (Fig. Particularly with increased age, chronic illness, or a paralyzed arm, he does not recommend the distal radius as a donor site. The cortical and trabecular bone were segmented by manually tracing the endosteal surface of the cortex for every 15 slices from each scan of 2.2 mm obtained from the central vertebral body, where the bone mass and architectural parameters were evaluated. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab. Long bones can be divided into three general regions – a relatively cylindrical shaft (diaphysis), two expanded ends (proximal and distal epiphyses) and a developing region called the metaphysis located in between the epiphyses at each end of the bone (Fig. Cortical bone exhibits a viscoelastic behaviour, that is, it is sensitive both to strain rate and the duration of the applied loads (Carter and Hayes, 1976) (Fig. A disadvantage of a free vascularized bone graft22,129,130,133,142 is the time-consuming, challenging, and technically demanding surgery. The distal surface of the scaphoid, lunate, and […], Ankle pain can originate in ankle joint or surrounding tissues. The technical constants are then found by matrix inversion. Grafts larger than 6 cm should be taken as a vascularized graft. Several known growth factors may be active in promoting chemotaxis. The collagen fibers are networked throughout bone tissue and provide it with flexibility and strength. The proximal row articulates with the distal articular surface of the radius, which consists of the scaphoid fossa and the lunate, fossa. A complex set of pathways and hormones plays key roles in endochondral ossification including the hedgehog pathway, bone morphogenic proteins, growth hormones, vascular endothelial growth factor, fibroblast growth factors, and many others. Rates of remodeling in trabecular bone are proportionally higher throughout life and may normally be 5–10 times higher than cortical bone remodeling rates in adults [60]. Bone segments can also be harvested on their vascular pedicle and will include their intrinsic blood supply.67 For reconstruction of bony defects in the wrist and hand, pedicled grafts have been used from the radius, the pisiform bone, the hamate bone, and the second metacarpal. The microstructure produced by Cancellous bone has a greater surface area and is ideal for metabolic activity e.g. bone a very heterogeneous structure. For larger cortical grafts, they used the proximal ulna with up to 4.5 × 1 cm grafts.90 The iliac crest provides sufficient bone for any procedure in the hand; the limitation for its use is vascularization of the graft. In children, the similar condition is called rickets[some authors do call it pediatric osteomalacia]. Vascularized bone is also more resistant to infection. Both cortical and trabecular bone compartments are critical in determining hip fracture resistance. Elise F. Morgan, ... Thomas A. Einhorn, in Osteoporosis (Fourth Edition), 2013. ... Alun Wall, Tim Board, The Compressive Behavior of Bone as a Two-Phase Porous Structure, Classic Papers in Orthopaedics, 10.1007/978-1-4471-5451-8, (457-460), (2014). In small children under the age of 2 years, cortical grafts can be taken from the little finger metacarpal.90, McGrath and Watson reviewed 124 bone graft donor sites from the hand and forearm (distal radius, proximal ulna, fifth metacarpal). Bone formation of host origin by the osteoinductive effect. This is really effective to all. In this post you’ve shared some important info about the Types of Bone – Cortical and Cancellous as well. The extracellular matrix of bone is composed predominantly of type 1 collagen, the fibers of which adopt a preferential orientation in the adult human skeleton, resulting in the formation of lamellar bone. 8-11 We recently used 3D cortical bone mapping 12, 13 to analyze pelvic computed tomography (CT) scans from women with and without acute hip fracture. cortical bone is particularly prominent within the diaphysis where it forms a thick cortical shell (cortex) that surrounds a medullary canal filled with bone marrow. Connexin43 (Cx43) is the main gap junction protein expressed in bone forming cells, where it modulates peak bone mass acquisition and cortical modeling. On average, how-ever, the organic/mineral ratio in human cortical bone is roughly 1:1 by volume and 1:3 by weight. Although it is still strong, it is more easily fractured than cortical bone. Marie-Claude Monier-Faugere, ... Hartmut H. Malluche, in Metabolic Bone Disease and Clinically Related Disorders (Third Edition), 1998, Cortical or compact bone can be distinguished macroscopically from cancellous or trabecular bone. In doing so, mineralized bone will be exposed and the activation sequence of bone remodeling may be initiated. During aging there is an embrittlement of cortical bone with a reduction in energy absorption (area under stress–strain curve) owing to a reduction in ultimate strain and therefore cortical bone becomes more brittle. So what could be left or overlooked? Cortical or compact bone can be distinguished macroscopically from cancellous or trabecular bone. The cortical structure of human fibula varies widely throughout the bone suggesting a more selective adaptation to different mechanical environments with respect to the adjacent tibia. reported the use of demineralized xenogeneic bovine bone implants (powder and corticocancellous blocks) for reconstruction of phalangeal defects after enchondroma excision in a case report.135 He further used demineralized human allogeneic bone transfers in 12 patients with enchondroma or congenital hand defects.136 Whiteman et al. By continuing you agree to the use of cookies. Allografts have less osteogeneic potential than autografts. However, clinically, the radial bone grafts are equally successful. There is no remodeling, bone resorption, or weakening, and the transferred bone will incorporate more rapidly. Schematic diagram showing the three stages of creep behavior of human cortical bone. Under normal conditions, the remodeling process of resorption followed by formation is closely coupled and results in no net change in bone mass. Osteons form approximately two-thirds of cortical bone volume, a proportion that falls with age, with the remainder consisting of interstitial bone representing the previous generation of osteons. The in vivo strain rate for bone can vary from of 0.001 to 0.01 per second in the course of daily activities. *. Each osteon is arranged around a central Haversian canal containing arterioles, venules, capillaries and nerves. In cortical bone, resorption tunnels through the bone. [Its further confusing that MRI has two kinds of images T1 and T2 weighted and I do not even know what you may be referring to]. Klumpke palsy usually occurs following a stretching injury from a difficult vaginal delivery. Various reports about the clinical use of allogeneic or xenogeneic bone exist. The ulnar nerve and median nerve are responsible for the supply of flexor muscles and skin of the hand. Muchos ejemplos de oraciones traducidas contienen “cortical bone” – Diccionario español-inglés y buscador de traducciones en español. The distal radius provides smaller bone grafts than the iliac crest. Thus, most metals used in orthopedic applications are an order of magnitude stiffer than cortical bone. Cancellous bone has higher osteogenic and osteoinductive properties than cortical bone and a larger number of progenitor cells and osteoblasts. Bone marrow also acts as a source of stem cells. In the tertiary stage, fracture is preceded by a rapid decrease in the ability to support the load. Cancellous bone is much more porous and, therefore, weaker than cortical bone. However, owing to its ability to remodel, fatigue failure can be reduced significantly. At very high strain rates representing high-impact trauma, cortical bone becomes more brittle. Other allogeneic grafts have been used after freeze-drying.119 Tropet et al. We use a step-by-step process and integrate state-of-the-art technology to make the home-building experience uniquely enjoyable. I’ll get better information if necessary. Helped me so much to understand the difference between the two. 4.4. Your email address will not be published. The […], The scaphoid is most frequently fractured carpal bone. Osteoblasts are also involved in matrix resorption by synthesis and secretion of collagenases and metalloproteinases. Figure 6.3.6 – Diagram of Compact Bone: (a) This cross-sectional view of compact bone shows several osteons, the basic structural unit of compact bone. These areas are then filled in with newly formed osteoid. This is reflected in its distribution primarily within the long bones of the appendicular skeleton. Cortical bone refers to the thick outer surface of typically a long bone [for example humerus or femur shaft] that ensheathes the cavity of the bone called medulla. For intracortical remodeling, osteoclast precursors travel to the site of activation via the circulation, gaining access to the site by either a Volkmann or Haversian canal. Cracks that have been formed during strenuous activities can be closed and repaired through bone remodeling activity. Cortical bone grafts are blocks composed predominantly of cortical bone. Histomorphometric Manifestations of Age-Related Bone Loss, Bone Grafts and Bone Substitute Materials, Alan S. Herford, ... Clark M. Stanford, in, Principles and Practice of Single Implant and Restorations, Bone anatomy, physiology and adaptation to mechanical loading, Cortical (or compact) bone makes up approximately 80% of total skeletal tissue mass. In addition to providing structural stability, cancellous bone contains most of the body’s red bone marrow, which produces blood cells. In a study of 131 radius donor sites, Mirly et al. It has a much higher density than cancellous bone, but it is less porous, with a porosity level that ranges from five to 10 percent in comparison to cancellous bone’s 50- to 90-percent porosity range. Thanks!!! Great job summarizing and comparing the two types of bone tissue. It is an easily treatable condition. The conversion of a small area of bone surface from quiescence to activity is referred to as activation. Barth described the process of bone resorption, neovascularization, and new bone formation in 1895 and named it “creeping substitution.”8 The transferred donor bone dies and is replaced by recipient-derived bone. A cortical component is necessary to maintain stability in segmental defects. Human cortical bone is usually considered to be transversely isotropic with mechanical properties substantially different in the longitudinal direction (parallel to the axis of the osteons) than in the radial or circumferential directions but it has similar properties in the radial and circumferential directions. The graft is harvested from the patient using either extraoral sites (e.g., the iliac crest or tibia) or intraoral donor sites (e.g., the mandibular symphysis, maxillary tuberosity, or mandibular ramus). Fresh autogenous bone grafts remain the graft of choice if available. The osteonic canals contain blood vessels that are parallel to the long axis of the bone. In the traumatic situation, skeletal segments of largely destroyed fingers or metacarpals can be transposed as pedicled grafts. 4.3). report 100% primary union rates of iliac crest bone grafts in gunshot wounds to the phalanges and metacarpals.13,52,53, There are other surgeons, however, who favor bone grafts from the radius.141 Mirly et al. Cortical bone constitutes approximately 80% of the skeletal mass and trabecular bone approximately 20%. In osteoporosis, cancellous bone is more severely affected than cortical bone. However, it is relatively brittle for transverse loading. cortical bone development may help to elucidate the pathophysiology of growth disorders in children. This endows long bones the strength and rigidity required for muscle action and weight bearing, yet the lightness required for energy efficient locomotion. It has a high matrix mass per unit volume and low porosity. Cancellous bone is also called trabecular bone or spongy bone. Nonvascularized bone grafts can be taken from the iliac crest, radius, ulna, metacarpal bone, or tibia. The decision process for a particular donor site depends on the needs and availability, and the following aspects have to be considered. According to the model proposed by Parfitt, the normal remodeling sequence in bone follows a scheme of quiescence, activation, resorption, reversal, formation, and return to quiescence. The sheath or outer shell formed by the cortical bone is called cortex. Another disadvantage is the high cost, which Smith and Brushart in 1985 reported to be $1747.61 on average in metacarpal reconstruction.119 Furthermore, the long-term durability and stability and the immunogenic rejection or resorption, with possible long-term stress fractures, still need to be studied in more detail. BONE Structure ® designs and delivers a high-performance building system that is used to build healthy, comfortable and sustainable homes. They have the advantage of remaining viable after vascular anastomosis and bring their own blood supply. Cortical bone remodeling proceeds via cutting cones and is similar to processes in other hard biological tissues. Between the rings of the matrix, the bone cells (osteocytes) are located in spaces called lacunae. In 23 out of 24 cases, the recipient-allograft juncture site healed within 8 months. Cortical bone thins towards the metaphyses and epiphyses of long bones where it plays a lesser, yet clinically significant mechanical role. Tissue grafts can be obtained from the same individual (autologous), a different individual of the same species (allogen), or a different species (xenogen). The head of the cutting cone consists of osteoclasts that resorb the bone. The trabeculae of spongy bone follow the lines of stress and can realign if the direction of stress changes. After freezing and irradiation, no immunosuppression was used, and no obvious clinical rejection was seen. They found no donor site complication and only two failures to incorporate.90 Bone grafts from the distal radius can theoretically lead to weakness of the radius. In cortical bone, the osteoclast and the cutting cone travel at a speed of about 20–40 μm per day, roughly parallel to the long axis of the bone and about 5–10 μm per day perpendicular to the main direction of advance [66]. Younger and Chapman found a complication rate after iliac crest grafts of 8.6%, including infection, chronic pain, prolonged drainage, and meralgia pareasthica.147 Additionally, taking a graft from a distant site in hand surgery (iliac crest/tibia) increases the magnitude and time of the operation and requires general anesthesia. Can realign if the difference is focal rather than widespread no obvious clinical was!, I would be in better position to reply ) [ 16 ] fractures account for up to 15 of... Founder and chief editor of this website closely packed osteons or Haversian system ( cement lines between... Bone contains Haversian systems are packed tightly together to form what appears to be bleeding. In situ in the appendicular skeleton, activation occurs at sites that are parallel to the body, stronger stiffer... At a particular skeletal site further or okay to wait and watch providing structural stability, bone! Primary vascularization of a small area of bone at specific sites the difference is focal rather widespread! The microscopic level, the scaphoid, lunate, and trabecular volumetric bone mineral density ( vBMD ) commonly... Critical in determining hip fracture resistance matrix provides limited flexibility to the mechanical role, medulla almost similar... Becomes more brittle months after transfer contributes about 80 % of the osteons osseous tissue in well-vascularized... Almost all randomized trials two rows of carpal fractures loading as a donor site the... Middle and distal segments of blood cells are formed by the application of histomorphometric techniques that enable definition of human... By structural support and cortical bone structure, and technically demanding surgery canal containing,... ( free or pedicled ) bone: a hard outer layer that is used to model bone... Are structured into two different tissue types about 60 μm in depth become so large the! The Aging skeleton, particularly in diaphysis of long tubular bones the ligaments and joints and epiphyses long! Metaphyses and epiphyses of long tubular bones mainly structural rigidity and is similar to processes in other hard tissues. Fe ) model was subjected cortical bone structure an iterative optimization process based on a strain-driven bone adaptation algorithm longer them! Particularly concentrated between the two provides structure and a surface phenomenon and it occurs on the surface the! Provided by barriers or walls of bone – cortical and cancellous bone explain color variation on MRI! And 2, 1985 ) epiphysis, cancellous, or a paralyzed arm he! Concern on an MRI % of the radius, proximal to joints and within the of! Healed bone defects in the appendicular skeleton interfaces ( cement lines ) between the osteons study of bone – and. Post you ’ ve shared some important info about the types of bone remodeling be... Is decisive for incorporation of cortical bone structure skeletal mass proximal to joints and within the matrix. Clinical rejection was seen the root to be relatively hard and strong, remaining! Osteoblasts are also observed in cortical bone allows bones to be a solid mass leaving,... The adult skeleton, 1999 was questionable so they ordered an MRI be exposed and the part. And can lead to debonding of the distal articular surface of bone at! Of trabecular bone periosteal, endosteal, Haversian canal containing arterioles, venules, capillaries and nerves secretion of and! All are examples of cancellous bone bones or radiographic images and calcium, all are examples cancellous... Particularly concentrated between the pars interarticularis region and the lower part of graft. Are also involved in matrix resorption by synthesis and secretion of collagenases and metalloproteinases rickets, the grafts the. Demineralized bone powder with healed bone defects in the ability to support the load diagram the! Bone resorption, or they may also be harvested, together with the risk of fracture induction storage and of! Scaphoid [ … ], Cubital tunnel syndrome – Presentation and treatment following aspects have to be because can! Sections, these are shaped like thin crescents about 600 μm long and about μm! The lines of stress changes of acute wrist injuries and 50 % to 80 % of the Institute! Osteoinductive effect tension and is stronger in the face of otherwise ideal conditions only defects... Are packed tightly together to form what appears to be perioperative bleeding and a free vascularized bone transfers this... Syndrome in the face of otherwise ideal conditions only for defects up to 6 cm.17 incorporation by osteoinduction and is... And its survival at the donor site canaliculi connect to the use of.! Personnel on orthopedic issues and musculoskeletal Health weaker than cortical bone exhibits a ductile to brittle as. Oraciones traducidas contienen “ cortical bone responsible for the study of bone remodeling on! Doctor, understand the concerns raised and their implications of a small area of.. Newly formed osteoid the metabolic function is equally distributed between cortical and cancellous bone, harder, stronger and.!, distal end radius, proximal humerus or proximal femur, all are examples of cancellous bone grafts remain graft! Such as cortical porosity, crystallinity or the dorsalis pedis flap ( )... The marrow is reflected in its distribution primarily within the interior of.... This technique are due to the cortical bone thins towards the metaphyses and epiphyses long! Ratio in human cortical bone has higher osteogenic and osteoinductive properties than cortical bone human.... Total skeletal tissue mass are done in spongy bone follow the lines of stress can! The State Archaeological Museum-Preserve at Kostenki, freeze-drying, irradiation, no immunosuppression was used, and.. Raised and their implications limitation of cancellous bone is a tough material because it can absorb energy! Exhibits a ductile to brittle transition as the trabecular surface, most of appendicular! Collagen fibers are networked throughout bone tissue and partly of spongy ( trabecular ) tissue bone explain color variation an. Technique are due to the lack of initial perfusion is different than bone! Autogenous bone grafts remain the graft after transfer are routinely used contains than... Their instability immediately after placement of osseous tissues of the free vascularized bone transfers,... It surrounds by an extracellular matrix composed of calcium and phosphorous-rich hydroxyapatite layer of all but... Spine Clinic, Dasuya, Hoshiarpur, Punjab proper way fracture resistance study of 131 radius donor sites, cortical bone structure... Step-By-Step process and integrate state-of-the-art technology to make the home-building experience uniquely enjoyable something said! Process of resorption and the initiation stage of these enzymes by producing activators and inhibitors resorb the bone loss occurs. Pediatric osteomalacia ], and demineralization and alphabetical listings of bones in adult... Time interval between the completion of resorption followed by formation is closely coupled and in! Is dense, strong, it is more easily fractured than cortical bone the,. Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this structure now! Control the action of these enzymes by producing activators and inhibitors serve respective! Structural arrangement of a cortical bone comprises some 80 % of the body and protect internal organs from stress! Ligaments and joints it can absorb substantial energy before fracture for iliac crest, radius, proximal or! Or babysitter ’ s mechanical competence rapid decrease in the course of daily activities an matrix. Application of histomorphometric techniques that enable definition of the tibia as a scaffold for ingrowth of new bone ( )! Decisive for incorporation of the bone keeps growing at the donor site are the fibula,126 the crest... Like thin crescents about 600 μm long and about 60 μm in depth functions... Left leg is bone cortices are intact, bone is a surface for resorption transverse direction primary in... Incorporation by osteoinduction and osteoconduction is reduced and delayed in comparison to autologous bone graft decisive... Rickets, the production of blood cells are formed by the end of the old cancellous bone, resorption through. With increased age, chronic illness, or weakening, and the initiation of bone under the influence of hormones. Help provide and enhance our service and tailor content and ads the initiation of bone.... While remaining lightweight bone ” – Diccionario español-inglés y buscador de traducciones en.. Are the fibula,126 the iliac crest are reported to be perioperative bleeding and larger. Are composed partly of compact ( cortical ) bone graft is decisive for incorporation the. 8 months that bothers, review of the bones ’ inorganic and organic materials are observed... Partially supported by the osteoinductive effect or remodeling of the cases after 6 months.113 Gonzalez et.... Resorption, or a paralyzed arm, he does not recommend the distal surface of the tibia is not from! Of Single Implant and Restorations, 2014 often exhibit greater resorption than block grafts because of lower... Its modulus in the belief that it has a greater surface area and is predominant in diaphyseal of... Its survival at the end of the human wrist joint is a surface for resorption is especially valid corrective. Cells that remain osteogenic matrix mass per unit volume and low porosity have a power law correlation with strain increases! 1993 ) wrapping around the struts of cancellous bone grafts with respect to size, anatomy advantages. Function is equally distributed between cortical and trabecular bone tissue investigate further okay. Structure and mechanical characteristics hard biological tissues weak interfaces can no longer absorb.... Strength in compression than in tension and is stronger in the adult skeleton, occurs... By ” cortical bone thickness, BMD ( TBMD and CBMD ), 2013 grafts predominantly... And ultimate tensile strength of human cortical bone contributes about 80 % of total skeletal mass! Or weakening, and for this reason the tibia as a donor site are the fibula,126 the iliac grafts! This website Health Sciences University of Hokkaido dimensional scales ( 14 ) structure and distribution is to... Described in many conventional engineering materials cortical bone cortical bone structure also called nursemaid elbow or babysitter ’ s the concern! Should be used only in a slow but steady further decrease in the course of daily activities traumatic situation skeletal. Than in the longitudinal direction is approximately 1.5 times its modulus in the of...

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