There are several types of fractures including closed fractures where the skin is intact, and open or compound fractures where there is a break in the skin. Fractures can also be classified based on their pattern such as linear, transverse, oblique, or comminuted. Fracture healing occurs in stages including haematoma formation, inflammation, soft callus formation, hard callus formation, and remodeling. Several factors can influence fracture healing including systemic factors like age, nutrition, and local factors related to the injury, treatment, and complications.

1. TYPES OF FRACTURES
,FRACTURE HEALING
STAGES AND FACTORS
INFLUENCING HEALING
MODERATOR :DR KUMAR CHANDAN
ASSISTANT PROFESSOR ORTHOPAEDIC
DEPARTMENT IGIMS,PATNA
SPEAKER :DR MOHSIN PARVEZ PGT 1ST YEAR
ORTHOPAEDIC DEPARTMENT IGIMS,PATNA

2. FRACTURE TYPES
RELATIONSHIP WITH EXTERNAL ENVIRONMENT : OPEN /COMPOUND (can be
internally open and externally open ) & CLOSED.
FRACTURE PATTERN :LINEAR ,TRANSVERSE,OBLIQUE,SPIRAL
,IMPACTED,AVULSION,SEGMENTAL
FRAGMENTS:INCOMPLETE,COMPLETE,COMMINUTED
DISPLACEMENT: NONDISPLACED ,DISPLACED
OTHER: PATHOLOGICAL ,STRESS,PERIPROSTHETIC ,HIGH VELOCITY INJURY
AND LOW VELOCITY INJURY
ON BASIS OF COMPLEXITY OF TREATMENT: SIMPLE AND COMPLEX

3. Closed fracture :overlying skin intact

4. Open/compound:open wound or break in skin near
site of broken and direct communication to the
external environment.
These are classified by gustilo anderson and tscherne and gotzen
classification

5. .Linear fracture :a break in bone but no
displacement.
Transverse:occurs straight across long axis
of body ,fracture usually remain in place
after reducton

6. .
Oblique :occur oblique to long axis of
bone at a angle that is not 90 degree.
Spiral :due to rotational force applied to
the bone commonly associated with
displacement.

7. .
Impacted:bone shatters into number of
pieces that are driven into one another at the
point of break, jammed together and fracture
line is indistinct.

8. .Comminuted fracture:break of bone into
more than two fragments
Considerable force and
Energy is required as
in vehicular accident.

9. .
Incomplete fractures:bone is incompletely
divided and periosteum remain in
continuity.greenstick fracture in children and
compression fracture in adult vertebral
bodies ets are few examples.

10. .
Pathological fracture:reserved for malignancy
either benign or malignant but is also used for
osteomyelitis and metabolic diseases associated
fractures ,spontaneous
or trivial trauma is seen

11. .Periprosthetic fracture :occur around implants
such as in in femur and hip are classified by
lewis and rorabeck for supracondylar femur
fracture and vancouver
classification for tha
periprosthetic fracture

12. Fracture healing stages and factors
influencing
Fracture healing is a complex process that requires the
recruitment of appropriate cells and subsequent
expression of appropriate genes at the right time and in
right anatomical direction.Fracture initiates sequence of
inflammation ,repair ,remodelling that can restore the
injured bone to its original state within few months.

13. .

14. .Modes of healing :primary bone healing /direct
union/intramembranous
via haversian remodelling
without a cartilaginous inter-
-mediate ,in rigid internal
fixation,without callous
formation.

15. .Healing by callus formation secondary bone healing most
common form in tubular bone in absence of rigid internal
fixation, five stages:
1:Haematoma formation
2:Inflammation
3:Soft callus formation
4:Hard callus formation

16. .
Rockwood and Green 8/e

18. .
Haematoma formation :Hematoma forms and provides
source of hematopoietic cells capable of
secreting growth factors.
Macrophages, neutrophils and
platelets release cytokines,site
becomes swollen,painful and
inflamed.

19. .
Inflammation :starts as soon as haematoma forms and
cytokines released and last until fibrous tissue cartilage or
bone formation 1-7 days post fracture fibroblasts
and mesenchymal cells migrate to
fracture site and granulation tissue forms
around fractured ends,osteoblasts
fibroblast and osteoclasts are active.

20. .Repair:Soft callus formation –
After 2–3 weeks, the
first soft callus is formed.The strain
applied to the cells in the fracture gap
modifies their growth factor expression
and progenitor cells are stimulated to
become osteoblasts. The cells form
a cuff of woven bone periosteally.

21. .Hard callus:Hard callus formation –
starts and lasts until the fragments
are firmly united (3–4 months).Bone
callus forms at the periphery of the
Fracture and progressively moves
centrally endochondral ossification
converts soft callus to hard callus
(woven bone).

22. .Remodelling:The woven bone is slowly replaced by
lamellar bone.This process can last from a few months to
several years ,chondrocytes undergo terminal
Differentiation
compact bone
is laid down to
reconstruct the
shaft walls

23. .
Factors influencing the bone healing
Systemic factors :age ,activity ,nutritional status,hormonal
factors,diseases,vitamin deficiencies,drugs, cns
trauma,nicotine ,alcohol.
Local factors: A :factors independent of injury,treatment
or complications-type of bone,abnormal
bone,denervation,infection ,radiation necrosis.

24. .B:factors depending on injury-degree of local
damage,extent of neurovascular injury,type and location
of injury,loss of bone,soft tissue interposition,local growth
factors.
C:factors depending on treatment-extent of surgical
trauma,implant induced altered blood flow,degree and
kind of rigidity of internal fixation
D:factors associated with complications-infection ,venous
stasis,metal allergy.

25. .
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