This document discusses fracture healing, describing the different types of fracture healing based on bone type, the stages of fracture healing from hematoma formation to remodeling, and the many factors that can influence and affect the fracture healing process. It outlines the basic tissue destruction and inflammatory response in the first week after injury, callus formation in weeks 2-3, consolidation from weeks 4-12 as new bone forms, and remodeling over months to years. Variables discussed include patient factors like age, diet, and medications; injury factors like open fractures; and treatment factors like stabilization methods.

1. FRACTURE HEALING
Dr. Akank Jha
Orthopedic resident
Deccan Multispeciality Hardikar Hospital, pune

2. INTRODUCTION
 Fracture is a break in the continuity of bone or
periosteum.
 The healing of fracture is in many ways similar to the
healing in soft tissue wounds except that the end
result is mineralised BONE.
 Fracture healing starts as soon as bone breaks and
continues modelling for many years.

3. FRACTURE HEALING TYPES
 Fracture healing is divided
according to bone:-
1. Cortical bone of the shaft.
2. Cancellous bone of the
metaphyseal region of the long
bones and the small bones.

4. FRACTURE HEALING TYPES

5. Components of BONE Formation
 Soft tissue
 Periosteum
 Cortex
 Bone marrow

7. Tissue destruction and Hematoma
formation
Day 1
 Torn blood vessels
haemorrhage
 A mass of clotted blood
(hematoma) forms at
the fracture site
 Site becomes swollen,
painful, and inflamed

8. Tissue destruction and Hematoma
formation

9. INFLAMATION AND CELLULAR
PROLIFERATION
Week 1
Within 8 hours
inflammatory reaction
starts.
Proliferation and
Differntiation of
mesenchymal stem cells.
Secretion of TGF-B , PDGF
and various BMP factors.

10. Callus Formation
Week 2-3

11. STAGE OF CONSOLIDATION
Week 4-12
 New bone trabeculae
appear in the fibro
cartilaginous callus.
 Fibro cartilaginous
callus converts into a
bony (hard) callus.
 continues until firm
union is formed 2-3
months later.

12. STAGE OF REMODELLING
Months to years
 Compact bone is laid
down to reconstruct
shaft walls

13. Type of BONE formed
 ENDOCHONDRAL OSSIFICATION
 INTRAMEMBERANOUS OSSIFICATION
 OPPOSITIONAL NEW BONE FORMATION

14. FACTORS EFFECTING
The TYPE , AMOUNT and LOCATION of bone formed
depends upon:
 FRACTURE TYPE
 GAP CONDITION
 FIXATION RIGIDITY
 LOADING
 BIOLOGICAL ENVIRONMENT

15. Variables Influence Fracture Healing
INJURY VARIABLES
Open Fractures
 preventing formation #
Hematoma
 Delaying formation
repair tissue
 Risk of infection

16. INJURY VARIABLES
Intra articular fractures
 If the alignment of joint
surface is not restored
1.Delayed healing or non
union

17. Patient Variables
 AGE

18. Variables that Influence Fracture
Healing
Patient factors
•Diet

19. Patient Variables
Systemic hormones
 Corticosteroid (decreases)
 Growth hormone
 Thyroid hormone
 Calcitonin
 Insulin
 Anabolic steroids
 DM
 Hypervitaminosis D
 Rickets
Nicotine Inhibit fracture healing ( decreases Vascularization)

20. Tissue Variables
 Cancellous or
cortical bones
 Bone necrosis
 Infection

21. Treatment Variables
Fracture
stabilization
 Traction
 Cast Imm
 Ext.Fixation
 Int.Fixation

22. Variables that Influence Fracture
Healing
 Internal variables
1. Blood supply (most important)
2. Mechanical factors
•bony soft tissue attachments
•mechanical stability/strain
•location of injury
•degree of bone loss

23. Variables that Influence Fracture
Healing
External variables
 Low Intensity Pulsed
Ultrasound (LIPUS)
•accelerates fracture
healing and increases
mechanical strength of
callus.

24. Variables that Influence Fracture
Healing
 Bone stimulators
•increase osteoblast
activity
•affect synthesis of
collagen and
calcification of carilage
•cause calcification of
fibrocartilage
•elevate
concentrations of TGF-
Beta and BMP

25. Variables that Influence Fracture
Healing
 COX-2
•promotes fracture healing by causing mesenchymal
stem cells to differentiate into osteoblasts

26.  HIV
higher prevalence of fragility fractures with
associated delayed healing

27. Variables that Influence Fracture
Healing
medications affecting healing
 Bisphosphonates are recognized as a cause of
osteoporotic fractures with long term usage
 Systemic Corticosteroids
higher rate of intertrochanteric fracture non unions
 Quinolones
toxic to chondrocytes and diminishes fracture repair

28. COMPLICATIONS OF
FRACTURE HEALING
 MALUNION
 DELAYED UNION
 NONUNION

29. Thank you