1. Dr. Shrikant GoreProf. of OrthopaedicsGovt. Medical College,Latur

2. Fracture HealingBone is vital & pulsating tissueEvery hour & every day bone grows& remodels & lives again 3. Stages of # HealingBroken Bone - Broken vessels HematomaRelease of proliferating factorsProliferation of endothelial cells, bone cells,mesenchymal cellsDifferentiation of proliferating cellsaccording to the need & environmentprovided 4. Stages of # HealingBlockage of capillaries to various extent-bonenecrosis (marrow-cortex-Periosteum)Proliferation factor released by plasmacells as a response to trauma to vascularchannelsCells with osteogenic potential derivedfrom endothelial cells, deeper layer ofperiosteal cells , bone cells proliferate 5. External CallusMost active proliferating cells from deeperlayer of Periosteum forms collar around the# bone ends thickening & growing towardseach-other to bridge the # gap by mergingwith each-other forming the OUTERCALLUSThe deeper layer gets vascularized osteoblastic activity laying new Trabicularbone 6. External CallusThe intermediate layer activelyproliferating- compact , less vascular-differentiatein cartilage Gradually beingreplaced by bone through endochondralossification- calcification-cell death-Vascularization- osteoblats - trabicular newboneThe outer layer of actively proliferating cells 7. Internal CallusWithin 2 days of injury marked vascularproliferation in the marrow cavity neoVascularization infiltration of mesenchymal cells differentiating in pre- osteoblats -Osteoblasts laying new bone trabeculae- bridging the #fragments INTERNAL CALLUSVascular sprouts start invading the dead bone at # endswith osteoclastic activity & removal of dead bone replaced by Osteoblastic activity & replacement by bone 8. Callus 9. Maturation of callus & RemodelingInitial callus is loosely woven bone likecancellous boneTrabicular pattern as per the requirement mechanical stressesMarrow callus- hemopiotic marrowcortex- compact bone with thickening alongthe lines of stress resorption of extra callus 10. Remodelling 11. Remodelling 12. Maturation of callus 13. SummaryBiochemical factors -Cellular response vascularresponseOsteoblastic & osteoclastic activitylaying down immature bone Osteoidmineralization to form- The CALLUSHaving irregular trabicular pattern unlikecancellous boneRemodeling to suit the functionalrequirements 14. Stages of Bone Healing 15. RequirementsReasonable opposition (Anatomical Reduction)Sufficient protection (rigid immobilization)Good blood supply (Quantity, Cellular)Healthy bone (cortical/ Cancellous / pathological)Environment (Foreign / Dead material /intra-articular#)Nutrition (Deficiencies, Metabolic )Immunological status (HIV, Corticosteroids) 16. General factorsAge-Young Bones are soft vascular and have very good capacity to formnew bone and remoldGrowing ends likely to get damaged resulting in growthdisturbanceAdult-Strong muscle force difficulty in getting &maintainingreductionOld Poor bone quality &blood supply- associated diseases-osteoporosis 17. General factorsSex-Postmenopausal osteoporosisNutrition-HemoglobinCalcium, Vit. D, Vit. C, & other vitamins - mineralsImmunity Immuno suppressive drugs, Chronic debilitating diseases DM,HT, TB, Malignancy, Chr. Lung diseases, Vascular diseasesHabits-Tobacco, alcoholNeurological diseases 18. Local Factors at fracture siteReduction GapSoft tissue interposition , excessive traction, bone loss,severe communition, loss of soft tissue attachment,improper fixation maintaining gap,Movement Poor immobilizationshearing, torsional, bending, stressesrepeated trauma hyperemia resorption of bone endsfibrous & cartilaginous differentiation of osteogeniccell 19. VascularityAnatomical susceptibilitySoft tissue damageCrushed boneExcessive intra- medullary reamingEdema & inflammationVascular injuriesVascular diseases- DM, Atherosclerosis, TAO,Varicose veins, Smoking 20. Anatomical susceptibility 21. Poor blood supply at one end 22. EnvironmentIntra-articular #Presence of synovial fluid having anti-thromboticactivityTamponadeInfectionHyperemia at # siteBacterial toxinsBone destruction,Vascular damage,Damage to immature bone 23. Bone QualityType of bones Cancellous bone,Cortical bone, Flat bones,Intra-articular fracturesPathology Developmental,Metabolic, Radiational,Neoplastic, infectionOsteoporosis 24. Hypertrophic Nonunion 25. Delayed union 26. Surgical InterferencePeriosteal damage,Damage to blood supply ,soft tissue damageMetal reaction,skeletal tractionInfection 27. Local Factors