Stages of bone healing and various factors by Dr Bipul Borthakur

1. STAGES OF BONE
HEALING AND VARIOUS
FACTORS.
DR. B. BORTHAKUR
PROFESSOR & HOD,
DEPARTMENT OF ORTHOPAEDICS, SMCH.

2. 1.Introduction.
2.Definition.
3.Stages of bone healing.
4.Types of fracture healing.
5.Biochemical steps of fracture healing.
6.Factors influencing bone healing.
7.Growth factors of bone.
8.Hormones affecting fracture healing.
9.Factors promoting bone healing.

3. INTRODUCTION:
“The healing process of a fracture is one of the
most remarkable of all repair processes in the
body since it results not in scar, but in the actual
reconstitition of injured tissue in very like it’s
original form... ”
B. McKibbin, 1978

4. DEFINITION
Bone healing is a cascade of biological
events leading to restoration of continuity and
mechanical property of bone.

5. STAGES OF BONE HEALING:
Stage 0: Injury and hematoma formation.
Stage 1: Inflammation.
Stage 2: Soft callus formation.
Stage 3: Hard callus formation.
Stage 4: Remodelling.

6. Stage 0: Injury and hematoma formation.
Duration : 0-4 hours.

7. Stage 1: Stage of inflammation.
Duration : 1-7 days.

8. Stage 2: Stage of soft callus formation.
Duration : 2- 3 weeks.

9. Stage 3: Stage of Hard callus formation.
Duration : 3 – 12 weeks.

10. Stage 4: Stage of Remodelling.
Duration: Months to years.

11. TYPES OF FRACTURE HEALING:
1. Direct fracture healing.
2. Indirect fracture healing.

12. Direct fracture healing:
• Occurs by absolute stability.
• Primarty healing occurs.
• No callus formation.
• Heal by direct osteonal remodelling.

13. Direct fracture healing

14. Absolute stability in Direct fracture healing
examples :
a) Lag screw
b) Compression plate

15. a) Lag screw

16. b) Compression plate

17. Indirect fracture healing:
• Under conditions of relative stability.
• Callus formation occurs.
• Occurs by secondary healing.

18. Indirect fracture healing

19. Examples of relative stability :

20. BIOCHEMICAL STEPS OF FRACTURE
HEALING:
• Mesenchymal.
• Chondroid.
• Chondroid – osteoid.
• Osteogenic.

21. FACTORS INFLUENCING BONE HEALING:
1. Mechanical factors.
2. Biological factors.

22. • Mechanical factors influencing bone healing:
a) Soft tissue attachment to bone.
b) Stability (extent of immobilization)
c) Extent of bone loss.
d) Level of energy impacted.

23. • Biological factors influencing bone healing:
a) Age .
b) Comorbidities associated.
c) Nutrition status.
d) Growth factors.
e) Any associated vascular injury.

24. Biological factors contd...
f) Type of bone affected.
g) Local pathologic conditions.
h) Smoking.
i) Sterility.
j) Soft tissue envelope.

25. GROWTH FACTORS OF BONE :
• Bone Morphogenic proteins (BMP)
• Transforming Growth Factor – beta ( TGF beta)
• Insulin-like Growth Factor (IGF-2)
• Platelet derived Growth Factor( PDGF).

26. Hormones affecting fracture healing:
1. Cortisone
2. Calcitonin.
3. Parathyroid Hormone ( PTH).
4. Growth Hormone.

27. FACTORS PROMOTING BONE HEALING:
•Therapy :
a) Movement of the limb.
b) Low intensity pulsed ultrasonography.
•Local biological enhancement:
a) Bone graft.
b) Bone Morphogenic Proteins
c) Growth factors.

28. Factors promoting bone healing contd....
•Systemic biological enhancement:
a) PTH.
b) Neuroproteins.

29. FACTORS IMPENDING BONE HEALING:
During the soft callus phase, too much
movement (excessive strain) risks tears in
repaired tissue and compromises callus
formation. This may cause delayed fracture
healing or non-union.

30. THANK YOU