A fracture is a broken bone that will heal whether or not a physician resets the bone. There are different types of fractures named according to their severity and location. The healing process of a fracture involves formation of a fracture hematoma, development of a fibrocartilaginous callus, formation of a bony callus, and remodeling of the bone. Stress fractures are microscopic cracks in the bone that result from repeated strenuous activity and can be detected using a bone scan.

2. • A fracture is a broken bone.
• It will heal whether or not a physician resets it in its
anatomical position.
• If the bone is not reset correctly, the healing process
will keep the bone in its deformed position.
• Fractures are named according to their severity, the
shape or position of the fracture line, or even the
physician who first described them.
1. Closed reduction: when a broken bone is
manipulated and set into its natural position
without surgery.
2. Open reduction: requires surgery to expose the
fracture and reset the bone.

3. • While some fractures can be minor, others are
quite severe and result in grave complications.
• For example, a fractured diaphysis of the
femur has the potential to release fat globules
into the bloodstream.
• These can become lodged in the capillary beds
of the lungs, leading to respiratory distress
and if not treated quickly, death.

4. Stress fracture:
• is a series of microscopic fissures in bone that forms
without any evidence of injury to other tissues.
• In healthy adults, stress fractures result from
repeated, strenuous activities such as running,
jumping, or aerobic dancing.
• Stress fractures are quite painful and also result
from disease processes that disrupt normal bone
calcification, such as osteoporosis.
• About 25% of stress fractures involve the tibia.
• Although standard x-ray images often fail to reveal
the presence of stress fractures, they show up
clearly in a bone scan.

5. • Fractures are classified by their complexity,
location, and other features.
• Some fractures may be described using more
than one term because it may have the
features of more than one type (e.g., an open
transverse fracture).

8. Bone Repair

9. The repair of a bone fracture involves
the following steps:
1. Formation of fracture hematoma.
2. Fibrocartilaginous callus formation.
3. Bony callus formation.
4. Bone remodeling.

10. 1- Formation of fracture hematoma:
• Blood vessels crossing the fracture line are broken.
• As blood leaks from the torn ends of the vessels, a mass of
blood (usually clotted) forms around the site of the fracture.
• This mass of blood, called a fracture hematoma, usually forms
6 to 8 hours after the injury.
• Because the circulation of blood stops at the site where the
fracture hematoma forms, nearby bone cells die.
• Swelling and inflammation occur in response to dead bone
cells, producing additional cellular debris.
• Phagocytes (neutrophils and macrophages) and osteoclasts
begin to remove the dead or damaged tissue in and around the
fracture hematoma.
• This stage may last up to several weeks.

12. 2- Fibrocartilaginous callus formation:
• Fibroblasts from the periosteum invade the fracture
site and produce collagen fibers.
• In addition, cells from the periosteum develop into
chondroblasts and begin to produce fibrocartilage
in this region.
• These events lead to the development of a
fibrocartilaginous (soft) callus: a mass of repair
tissue consisting of collagen fibers and cartilage that
bridges the broken ends of the bone.
• Formation of the fibrocartilaginous callus takes
about 3 weeks.

14. 3- Bony callus formation:
• In areas closer to well-vascularized healthy bone
tissue, osteogenic cells develop into osteoblasts,
which begin to produce spongy bone trabeculae.
• The trabeculae join living and dead portions of
the original bone fragments.
• In time, the fibrocartilage is converted to spongy
bone, and the callus is then referred to as a bony
(hard) callus.
• The bony callus lasts about 3 to 4 months.

16. 4- Bone remodeling:
• Dead portions of the original fragments of
broken bone are gradually resorbed by
osteoclasts.
• Compact bone replaces spongy bone around the
periphery of the fracture.
• Sometimes, the repair process is so thorough
that the fracture line is undetectable, even in a
radiograph (x-ray).
• However, a thickened area on the surface of the
bone remains as evidence of a healed fracture.

19. • Although bone has a generous blood supply,
healing sometimes takes months.
• The calcium and phosphorus needed to
strengthen and harden new bone are deposited
only gradually, and bone cells generally grow
and reproduce slowly.
• The temporary disruption in their blood supply
also helps explain the slowness of healing of
severely fractured bones.