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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