Fracture healing srinath


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Fracture healing srinath

  2. 2.  FRACTURE  Disruptions of bone tissue  FRACTURE HEALING  It is a complex process that requires recruitment of appropriate cells(fibroblasts, macrophages, chondroblasts, osteoblasts, osteoclasts) and subsequent expression of the appropriate genes(genes that control matrix production and organisation, growth factors, transcription factors)
  3. 3.  Bone regeneration is the appropriate term  Bone healing is unique that there is no scar at the place of impact THREE PHASES OF HEALING Inflammatory phase Reparatory phase Remodelling phase
  4. 4. INFLAMMATORY PHASE PMN macrophages  angiogenesis Vessels dilate Acute edema Inflammatory mediators(TGFβ, acidic fibroblast growth factor, basic fibroblast growth factor, PDGF) Dead cells, platelets, injured cells Hematoma formation ( fibrin in hematoma attracts reparative cells) Fracture of the bone destroys the cells, blood vessels, bone matrix, periosteum and muscles
  5. 5. REPARATORY PHASE enchondral ossification , hard callus enlargement, increase in the stability of fractured fragments Hard callus – the bone that is formed in the periphery of the callus by intramembranous bone formation Soft callus – forms in the central region of the fractured bone Primarily of cartilage and fibrous tissue Callus – comprises fibrous tissue,cartilage , woven bones After inflammation subsides fibroblasts and chondrocytes appear in the site leading to callus formation
  6. 6. REMODELLING PHASE Callus diameter decreases in size The medullary canal is reconstituted Woven bone is converted into lamellar bone
  7. 7. Methods of fracture healing
  8. 8. INDIRECT  This is most common method of fracture healing  POP is based on this
  9. 9. Hunter’s staging • from the moment of impact to the fracture of the bone Stage of impact • the cells involved in the callus formation is induced by BMP, low oxygen tension, bioelectric Stage of induction • hemorrhage, angiogenesis, cellular infilatration Stage of inflammation
  10. 10. • blood from torn vessel collects • Hematoma formation • organised with fibrous tissue, cartilage Stage of hematoma • intercellular matrix formation with calcium salt deposition stage of callus • woven bone to lamellar bone • haversion remodelling • normal cortical bone structure attained stage of remodelling
  11. 11. FROST STAGING stage of hematoma stage of granulation tissue stage of callus stage of remodelling stage of modelling
  12. 12. DIRECT BONE HEALING  healing by primary intention  no callus formation  anatomically reduced and fixed  open procedure with plates and screws  healing occurs by osteon - osteon hook up by direct haversion remodelling  Osteoclasts  cut the bone, osteoblasts -paste the bone
  13. 13. DISTRACTION HISTEOGENESIS healed by gradual distraction of osteomies clinical union – fracture site is stable and pain free radiological union – x ray shows bone trabeculae and cortical bone at fracture site
  14. 14. FACTORS INFLUENCING FRACTURE HEALING  SYSTEMIC FACTORS  Age  Children heals earlier than adults  Sex  same  Activity level  Adequate immobilisation  Nutrional status
  15. 15.  Hormone factors  Growth hormone  Corticosteroids  Sex hormones  Thyroid and parathyroid  calcitonin  Diseases  DM  Anemia  Scabies  neuropathies  Vitamin deficiencies  A,D,C,K
  16. 16.  Drugs and other substances  Nsaids  Phenytoin  Tetracyclines  Nicotine alcohol  Hypoxia  Systemic growth factors  Environmental temperature  CNS trauma
  17. 17. LOCAL FACTORS  Factors independent of injury, treatment and complication  Type of bone – flat and cancellous bone quick healing  Abnormal bones – radiation necrosis, infection, tumors
  18. 18. Factors depending on injury  Degree of local damage – compound #, comminute#, velocity of injury, ,  type and location  pattern of # - spiral<oblique<transverse  loss of bone  soft tissue interposition
  19. 19. Factors depending on treatment  Implants  Extent of surgical trauma  Degree of rigidity of external and internal fixation  Extent of contact between fragments
  20. 20. Factors associated with complications  Infection  Venous stasis  Metal allergy
  21. 21. Failure of fracture healing  Delayed union  Non union(hypertrophic and atrophic)  Fibrous union