brief review about fracture , types of fractures ,healing process !!

1. JSS HOSPITAL
MYSORE

2. BY :: DR ASHWANI PANCHAL
P.G IN ORTHOPAEDICS
ORTHOPAEDICS DEPT
JSS HOSPITAL, MYSORE

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INTRODUCTION
CLASSIFICATION OF FRACTURE
TYPES OF FRACTURE
HEALING OF FRACTURE

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FRACTURE IS DEFINED AS
“ BREAK IN THE CONTINUITY OF BONE”.
BREAK DOWN OF BONE IN TWO OR MORE
THEN TWO PARTS.
Fractures results from :1} injury
2} repetitive stress
3} Abnormal weakness

5. ON THE BASIS OF AETIOLOGY
2. ON THE BASIS OF
DISPLACEMENTS
ON THE BASIS OF RELATIONSHIP
WITH EXTERNAL ENVIRONMENT
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[ a. ] Traumatic fracture –
sustained due to any
trauma… e.g. : # caused
by a fall , RSA etc
[ b. ] Pathological fracture
– it is a # through a bone
which has been made
weak by some underlying
disease
e.g :: # through a
bone weakened by
metastasis,osteoporosis.

7.  A.UNDISPLACED # :: fracture with
absence of significant displacement
 B.DISPLACED # : there is displacement
of fragment of a bone
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FACTORS :
# force
Muscle pull on the # fragment
Gravity

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[a] SIMPLE/CLOSED
A fracture not
communicating with
ext. environment or
skin is intact or if
there is any wound
these are superficial {
unrelated to the
fracture }

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A fracture with
break in the
overlying skin and
soft tissues ,leading
to the fracture
communicating
with the ext.
environment

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Simple fracture
Spiral fracture
Transverse fracture
Oblique fracture
Comminuted fracture
Greenstick fracture
Segmental fracture
Depressed fracture
Compression fracture
Green stick fracture
Hairline fracture

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Usually caused by directly applied force to
fracture site
# line is perpendicular to the long axis of the
bone

13. In this type of the
fracture the crack
only extends into
the outer layer of
the bone but not
completely
through the entire
bone. It is also
known as a Fissure
Fracture.

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Caused by violence transmitted through limb
from a distance (twisting movements)
Oblique -# line is obligue
Spiral -#line runs spirally in more than one
plane

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Two or more bone pieces - high energy
trauma
# with multiple fragments

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There are two
fractures in one
bone at different
levels

17. The fracture in
which one side of
the bone is broken
and the other side
is bent.

18. Impacted fractures:
•
broken bone ends are forced into each other
•Cancellous bone is usually invovled and union is often rapid
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Impacted fracture

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Caused by traction,
bony fragment usually
torn off by a tendon or
ligament.

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Introduction
Fracture healing is a complex process that
requires the recruitment of appropriate cells
([[[[fibroblasts, macrophages, chondroblasts,
osteoblasts, osteoclasts]]]]) and the
subsequent expression of the appropriate
genes [[[[(genes that control matrix
production and organization, growth factors,
transcription factors]]]]]) at the right time and
in the right anatomical location

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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
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In 1989, FROST proposed the stages of fracture
healing
five stages.
stage of haematoma
stage of granulation tissue
stage of callus
stage of modelling
stage of remodelling

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There are 3 major phases with sub
divisions:
A. Reactive Phase:
◦ i. Fracture and inflammatory phase.
◦ ii. Stage of hematoma formation.
◦ iii. Granulation tissue formation.
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B. Reparative Phase:
◦ iv. Cartilage Callus formation.
◦ v. Lamellar bone deposition.
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C. Remodeling Phase:
◦ vi. Remodeling to original bone contour.
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I .Fracture &
inflammatory phase :
After fracture the first
change seen is the
presence of blood cells
within the tissues which
are adjacent to the injury
site. Soon after fracture,
the blood vessels constrict,
stopping any further
bleeding.
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ii. Stage of Hematoma formation:
Within a few hours after fracture, the
extravascular blood cells form a
blood clot, known as a hematoma. All
of the cells within the blood clot
degenerate and die.
The fracture hematoma immobilizes
& splints the fracture.
The fracture haematoma provides a
fibrin scaffold that facilitates
migration of repair cells.
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26. iii. Granulation Tissue Formation:
Within this same area,
the fibroblasts survive and replicate.
They form a loose aggregate of
cells, interspersed with small blood
vessels, known as granulation tissue
which grows forward, outside and
inside the bone to bridge the
fracture.
They are stimulated by vasoactive
mediators like serotonin and
histamine.
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iv. Cartilage Callus formation :
Days after the # the periosteal cells proximal
to the fracture gap and fibroblasts develop
into chondroblasts which form hyaline
cartilage.
The periosteal cells distal to the fracture gap
develop into osteoblasts which form woven
bone. These 2 tissues unite with their
counterparts and culminate into new mass of
heterogenous tissue called Fracture Callus
restoring some of its original strength.
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vi. Remodelling to original bone
contour:
The remodeling process substitutes the
trabecular bone with compact bone. The
trabecular bone is first resorbed
by osteoclasts, creating a shallow
resorption pit known as a "Howship's
lacuna".
Then osteoblasts deposit compact bone
within the resorption pit.
Eventually, the fracture callus is
remodelled.
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The healing of fracured cancellous bone
follows a different pattern
The bone is of uniform spongy texture and
has no medullary cavity , so that there is
large area of contact between the trabeculae
Union can occur directly between the bony
surfaces without having to pass through the
stage of callus formation
Following haematoma nd granulation
formation,mature osteoblasts lay down
woven bone in the intercellular matrix,and
the two fragments thus unite.

30. THANK U
ORTHOPAEDICS DEPTT JSS HOSPITAL ..MYSORE