FRACTURE HEALING
D SRINATH FINAL YEAR M.B.B.S
FRACTURE Disruptions of bone tissue FRACTURE HEALINGIt is a complex process that requires
recruitment of appropriate cells(fibroblasts, macrophages, chondroblasts, osteoblasts, osteoclasts) and subsequent expression of the appropriate genes(genes that control matrix production and organisation, growth factors, transcription factors)
Bone regeneration is the appropriate termBone healing is unique that there is no scar
at the place of impact
THREE PHASES OF HEALING
Inflammatory phase
Reparatory phase
Remodelling phase
INFLAMMATORY PHASE
REPARATORY PHASE
REMODELLING PHASE
Methods of fracture healing
INDIRECT This is most common method of fracture
healingPOP is based on this
Hunter’s stagingStage of impact
• from the moment of impact to the fracture of the bone
Stage of induction
• the cells involved in the callus formation is induced by BMP, low oxygen tension, bioelectric
Stage of inflammation
• hemorrhage, angiogenesis, cellular infilatration
Stage of hematoma
• blood from torn vessel collects• Hematoma formation• organised with fibrous tissue, cartilage
stage of callus
• intercellular matrix formation with calcium salt deposition
stage of remodelling
• woven bone to lamellar bone• haversion remodelling• normal cortical bone structure attained
FROST STAGINGstage of hematoma
stage of granulation tissue
stage of callus
stage of remodelling
stage of modelling
DIRECT BONE HEALINGhealing by primary intentionno callus formationanatomically reduced and fixed open procedure with plates and screwshealing occurs by osteon - osteon hook up by
direct haversion remodellingOsteoclasts cut the bone, osteoblasts -paste the bone
DISTRACTION HISTEOGENESIShealed by gradual distraction of osteomies
clinical union – fracture site is stable and pain free
radiological union – x ray shows bone trabeculae and cortical bone at fracture site
FACTORS INFLUENCING FRACTURE HEALINGSYSTEMIC FACTORS Age
Children heals earlier than adultsSex
sameActivity level
Adequate immobilisationNutrional status
Hormone factorsGrowth hormoneCorticosteroidsSex hormonesThyroid and parathyroidcalcitonin
DiseasesDMAnemiaScabiesneuropathies
Vitamin deficienciesA,D,C,K
Drugs and other substancesNsaidsPhenytoinTetracyclinesNicotine alcohol
HypoxiaSystemic growth factorsEnvironmental temperatureCNS trauma
LOCAL FACTORSFactors independent of injury, treatment and complicationType of bone – flat and cancellous bone
quick healingAbnormal bones – radiation necrosis,
infection, tumors
Factors depending on injuryDegree of local damage – compound #, comminute#, velocity of injury, ,
type and locationpattern of # - spiral<oblique<transverse
loss of bonesoft tissue interposition
Factors depending on treatmentImplantsExtent of surgical traumaDegree of rigidity of external and internal fixation
Extent of contact between fragments
Factors associated with complicationsInfectionVenous stasisMetal allergy
Failure of fracture healing
Delayed unionNon union(hypertrophic and atrophic)Fibrous union
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