Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Orthopaedics PPT 8 General Outline of Fractures And Fracture Healing Lecture Notes
General outline of fractures
and fracture healing
Learning objectives
? Anatomy
? Types of fractures
? Mechanism of injury
? Morphology of various fracture types
? General healing principles
? Types of healing
Anatomy
? Bone has been divided into-
a. Epiphysis
b. Metaphysis
c. Diaphysis
Types of bone
? Cancellous/Spongy
? Cortical/Compact
Fractures
? Break in the structural continuity of bone
Types of Fracture
? Divided into
? Complete
? Incomplete
Types of Fractures
? Based on aetiology-
A. Traumatic
B. Pathological
C. Stress
Types of fractures
? Based on Displacement-
A. Undisplaced
B. Displaced- Translation,
angulation, twisting
Types of Fractures
? Based on relationship to external environment
A. Closed
B. Open
? Based on Pattern
A. Spiral
B. Oblique
C. Transverse
D. Communited
E. Segmental
Open fracture
Open fracture
Mechanism
? Injury
? Repeated Trauma
? Pathological Fracture
Injury
? Low velocity
? High velocity
Mechanism
Some fracture patterns reveals the dominant
mechanism:
Spiral pattern- twisting
Oblique- compression
Triangular- bending
Transverse- tension
Extent of displacement
? Force of injury
? Effects of gravity
? Pull of muscles attached to site
Repeated trauma
? Occur in normal bone, subject to repeated heavy loading, typical y
in athletes, dancers or military personnel.
? Drugs like steroids and methotrexate
Stress fracture
PATHOLOGICAL FRACTURES
? Occurs in a bone that is made weak by some disease.
? Causes-
Inflammatory- Osteomyelitis
Neoplastic- giant cell tumor, Ewing's sarcoma, secondaries
Pathological fracture
? Miscel aneous bone conditions- simple bone cyst, anuerysmal bone
cyst, metastasis
? Hereditary- Osteogenesis imperfecta, Osteopetrosis
? Other acquired generalised diseases- Osteoporosis, osteomalacia,
rickets
Pathological fracture
Fracture healing
? Process of proliferative physiological process in which body
facilitates healing with various cells and growth factors
? Cells- Osteoblast, Osteoclast main cells
? Various growth factors
HISTORY
?
In 1975, Cruess and Dumont proposed that fracture healing may be considered
to consist of three overlapping phases: an inflammatory phase, a
reparative phase, and a remodeling phase
? In 1989, FROST proposed the stages of fracture healing
five stages.
stage of hematoma
stage of granulation tissue
stage of cal us
stage of consolidation
stage of remodel ing
HEALING BY CALLUS
? STAGE 1: TISSUE DESTRUCTION AND
HEMATOMA FORMATION
- lasts for 7 days
- blood leaks out of torn vessels and forms
a hematoma between and around
fracture
- periosteum and local soft tissues are
stripped off
- ischaemic necrosis ? death of some
osteocytes with sensitization of the
remaining precursor cel s
? STAGE 2: INFLAMMATION AND CELLULAR
PROLIFERATION/GRANULATION TISSUE
- lasts for 2-3 weeks
- precursor cel s form cel s that
differentiate and organize to provide
vessels, fibroblasts, osteoblasts etc
- soft granulation tissue formed between
fracture fragments, providing anchorage
to fracture
- hematoma is slowly absorbed and fine
new capillaries grow into the area
? STAGE 3: CALLUS FORMATION
- lasts for 4-12 weeks
- granulation tissue differentiates and
creates osteoblasts, laying down
intercellular matrix impregnated with
calcium salts
- formation of callus/woven bone
- provides good strength to the fracture,
decreasing the movements at the fracture
site and causes union in about 4 weeks
? STAGE 4: CONSOLIDATION
- takes 1-4 years for the bone to become
strong enough to carry weight
- with continuing osteoclastic and
osteoblastic activities, the woven bone
gets transformed into lamel ar bone
- osteoblasts fill in the remaining gap
between the new bone and the
fragments to strengthen the bone
? STAGE 5: REMODELLING
- stage where the bone is gradually
strengthened
- shapening of the cortices occurs at the
endosteal and periosteal surfaces
- al these occur when the person starts
resuming his activities ie bearing weight
and muscle forces
- thicker lamel ae are laid down where high
stresses are present, unwanted buttresses
are carved away and medullary cavity is
reformed
Types for Bone Healing
? Direct (primary) bone healing
? Indirect (secondary) bone healing
Direct Bone Healing
? Mechanism of bone healing seen when there
is no motion at the fracture site (i.e. absolute
stability)
? Does not involve formation of fracture callus
? Osteoblasts originate from endothelial and
perivascular cells
Components of Direct Bone
Healing
? Contact Healing
? Direct contact between the fracture ends al ows healing
to be with lamel ar bone immediately
? Gap Healing
? Gaps less than 200-500 microns are primarily fil ed with
woven bone that is subsequently remodeled into lamel ar
bone
? Larger gaps are healed by indirect bone healing
(partial y fil ed with fibrous tissue that undergoes
secondary ossification)
Direct Bone
Healing
Indirect Bone Healing
? Mechanism for healing in fractures that
have some motion, but not enough to
disrupt the healing process.
? Bridging periosteal (soft) cal us and
medul ary (hard) cal us re-establish
structural continuity
? Cal us subsequently undergoes
endochondral ossification
? Process fairly rapid - weeks
Q1
? A patient has come to our emergency with fracture tibia of right side
with wound on anteriomedial aspect of shin of tibia of 3 cm. the
wound can be closed by primary suturing as appear on secondary
examination. Patient had an rta 2 hours back. Please classify the
fracture according to gustilo Anderson classification?
a. Grade I
b. Grade II
c. Grade II a
d. Grade II b
Q2
? How is direct fracture healing differ from indirect fracture healing?
a. Stage of hematoma
b. Stage of callus formation
c. Stage of remodeling
d. Stage of consolidation
Q3
A 70 year old male patient developed pain in his left shoulder while
turning in bed. He is a known case of pulmonary malignancy and is on
chemotherapy for the same. Xray shows a lytic lesion in the proximal
humerus with a fracture. How will you classify this fracture/
a. Traumatic fracture
b. Pathological fracture
c. Stress fracture
d. None of the above
Q4
? A football player twisted his ankle when his foot got stuck in the ditch
on the ground. The foot was fixed and the whole weight of the body
acted on the ankle. If he has swelling and tenderness on the lateral
side of ankle. What kind of fracture do you expect in the fibula?
a. Transverse fracture
b. Spiral fracture
c. Oblique fracture
d. Communited fracture
Q5
While doing a closed nailing in a case of closed fracture shaft of femur
what kind of healing do you expect in this case?
a. Direct healing
b. Indirect healing
c. Combination of direct and indirect healing
d. None of the above
This post was last modified on 07 April 2022