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Bone Fracture Healing Process
1.
2. • A fracture is a broken bone.
• It will heal whether or not a physician resets it in its
anatomical position.
• If the bone is not reset correctly, the healing process
will keep the bone in its deformed position.
• Fractures are named according to their severity, the
shape or position of the fracture line, or even the
physician who first described them.
1. Closed reduction: when a broken bone is
manipulated and set into its natural position
without surgery.
2. Open reduction: requires surgery to expose the
fracture and reset the bone.
3. • While some fractures can be minor, others are
quite severe and result in grave complications.
• For example, a fractured diaphysis of the
femur has the potential to release fat globules
into the bloodstream.
• These can become lodged in the capillary beds
of the lungs, leading to respiratory distress
and if not treated quickly, death.
4. Stress fracture:
• is a series of microscopic fissures in bone that forms
without any evidence of injury to other tissues.
• In healthy adults, stress fractures result from
repeated, strenuous activities such as running,
jumping, or aerobic dancing.
• Stress fractures are quite painful and also result
from disease processes that disrupt normal bone
calcification, such as osteoporosis.
• About 25% of stress fractures involve the tibia.
• Although standard x-ray images often fail to reveal
the presence of stress fractures, they show up
clearly in a bone scan.
5. • Fractures are classified by their complexity,
location, and other features.
• Some fractures may be described using more
than one term because it may have the
features of more than one type (e.g., an open
transverse fracture).
9. The repair of a bone fracture involves
the following steps:
1. Formation of fracture hematoma.
2. Fibrocartilaginous callus formation.
3. Bony callus formation.
4. Bone remodeling.
10. 1- Formation of fracture hematoma:
• Blood vessels crossing the fracture line are broken.
• As blood leaks from the torn ends of the vessels, a mass of
blood (usually clotted) forms around the site of the fracture.
• This mass of blood, called a fracture hematoma, usually forms
6 to 8 hours after the injury.
• Because the circulation of blood stops at the site where the
fracture hematoma forms, nearby bone cells die.
• Swelling and inflammation occur in response to dead bone
cells, producing additional cellular debris.
• Phagocytes (neutrophils and macrophages) and osteoclasts
begin to remove the dead or damaged tissue in and around the
fracture hematoma.
• This stage may last up to several weeks.
11.
12. 2- Fibrocartilaginous callus formation:
• Fibroblasts from the periosteum invade the fracture
site and produce collagen fibers.
• In addition, cells from the periosteum develop into
chondroblasts and begin to produce fibrocartilage
in this region.
• These events lead to the development of a
fibrocartilaginous (soft) callus: a mass of repair
tissue consisting of collagen fibers and cartilage that
bridges the broken ends of the bone.
• Formation of the fibrocartilaginous callus takes
about 3 weeks.
13.
14. 3- Bony callus formation:
• In areas closer to well-vascularized healthy bone
tissue, osteogenic cells develop into osteoblasts,
which begin to produce spongy bone trabeculae.
• The trabeculae join living and dead portions of
the original bone fragments.
• In time, the fibrocartilage is converted to spongy
bone, and the callus is then referred to as a bony
(hard) callus.
• The bony callus lasts about 3 to 4 months.
15.
16. 4- Bone remodeling:
• Dead portions of the original fragments of
broken bone are gradually resorbed by
osteoclasts.
• Compact bone replaces spongy bone around the
periphery of the fracture.
• Sometimes, the repair process is so thorough
that the fracture line is undetectable, even in a
radiograph (x-ray).
• However, a thickened area on the surface of the
bone remains as evidence of a healed fracture.
17.
18.
19. • Although bone has a generous blood supply,
healing sometimes takes months.
• The calcium and phosphorus needed to
strengthen and harden new bone are deposited
only gradually, and bone cells generally grow
and reproduce slowly.
• The temporary disruption in their blood supply
also helps explain the slowness of healing of
severely fractured bones.