all about bone healing by Dr Akank Jha

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