Scribd
Upload
64 views

Fracture Healing: Presenter: DR Mugi Ortho Resident

Fracture Healing presentation for orthopedic residents. Highlights the anatomy, types of fracture healing, the complications and management of each complication.

Uploaded by

Phoenix Merchants
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
64 views

Fracture Healing: Presenter: DR Mugi Ortho Resident

Fracture Healing presentation for orthopedic residents. Highlights the anatomy, types of fracture healing, the complications and management of each complication.

Uploaded by

Phoenix Merchants
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 32

FRACTURE HEALING

PRESENTER: DR MUGI
Ortho resident.
FORMAT

• DEFINITION

• STAGES OF FRACTURE HEALING

• FACTORS AFFECTING FRACTURE HEALING

• COMPLICATIONS OF FRACTURE HEALING


• Fracture is a break in the structural continuity of bone or periosteum

• Fracture healing starts as soon as bone breaks and continues


modelling for many years.
Cells and Tissues Involved in Fracture Healing

• Progenitor cells from periosteum and endosteum

• Chondrocytes

• Osteoblasts

• Osteoclasts

• Inflammatory cells eg Platelets, neutrophils, macrophages, and leukocytes

• Muscles
Modes of bone healing
Fracture stability dictates the type of healing that will occur

• when the strain is below 2%, primary bone healing will occur

• when the strain is between 2% and 10%, secondary bone healing will
occur
 Primary bone healing
• intramembranous healing

• occurs via Haversian remodeling

• occurs with absolute stability constructs

• manifests as loss of the obvious fracture line with an absence of


visible fracture callus on postoperative radiographs
Secondary bone healing
• involves responses in the periosteum and external soft tissues.

• endochondral healing 

• occurs with non-rigid fixation, as fracture braces, external fixation,


bridge plating, intramedullary nailing, etc.
• Type of Fracture Healing with Treatment Technique

•Cast treatment •Secondary: endochondral ossification

•External fixation •Secondary: endochondral ossification

•IM nailing    •Secondary: endochondral ossification

•Compression plate •Primary: Haversian remodeling


STAGES OF SECONDARY FRACTURE
HEALING
• Tissue destruction and hematoma formation

• Inflammation and cellular proliferation

• Stage of soft callus formation

• Stage of consolidation (hard callus)

• Stage of remodeling
Tissue destruction and Hematoma formation
• Torn blood vessels hemorrhage

• A mass of clotted blood (hematoma) forms at the fracture site

• Hematoma forms and provides a source of hematopoietic cells


capable of secreting growth factors. 

• Takes within 24 hours

• Fracture hematoma is bioactive with immunologic activity


INFLAMATION AND CELLULAR
PROLIFERATION
• Macrophages, neutrophils, and platelets release several cytokines

• Orchestrate the subsequent healing process by phagocytosing


necrotic tissue and by producing cytokines that influence the repair
process.
Soft callus
• Begins around the 3rd week after a fracture

• heralded by the differentiation of progenitor cells into chondrocytes and

osteoblasts

• Mechanical testing reveals the stability of soft tissue rather than a consolidated

mass that confers bone stability.

• Radiographically, the fracture site does not appear united at this stage, but a

fluffy appearance of the early mineralizing callus may start to be detected.


Hard callus
• conversion of cartilage to a calcified cartilage matrix with terminal differentiation

of the chondrocytes

• hypertrophic chondrocytes senesce and blood vessels invade

• the callus.

• dominant cell types during the hard callus phase are the osteoblast and osteoclast

• Clinically, this phase of healing is seen as the calcification and consolidation of the

fracture callus on radiographs.


STAGE OF REMODELLING
• Returns the previously damaged tissue nearer to its pre-injured state

• Compact bone is laid down to reconstruct shaft walls

• It’s a continuous process

• Newly formed bone (woven bone) is remodeling via organized


osteoblastic/osteoclastic activity

• Shaped through Wolff's law: bone remodels in response to mechanical


stress
Variables Influencing Fracture Healing

INJURY VARIABLES

Open Fractures

• Impede or prevent formation of # Hematoma

• Delay formation repair tissue

• Risk of infection
Patient Variables

• Diet deficient in vitamin D and calcium

• diabetes mellitus. affects the repair and remodeling of bone

• Smoking

• HIV

• Medications
Systemic hormones
• Increase rate of fracture healing: growth hormone, thyroid hormone,
calcitonin, insulin

• Decrease rate of fracture healing: corticosteroids, anabolic steroids,


DM, hypervitaminosis D and rickets
Tissue Variables
• Whether Cancellous or cortical bones
• Bone necrosis
• Presence of Infection
Bone disease
• Osteoporosis

• Osteomalacia

• Primary malignant bone tumors

• Metastatic, Benign bone tumors

• Bone cysts

• Osteogenesis imperfecta

• Hyperparathyroidism
Treatment Variables

Apposition of fracture fragments

• Loading & micro motion

Fracture stabilization

• Traction, Cast Immobilization, Ext. Fixation, Int.Fixation


COMPLICATIONS OF FRACTURE
HEALING
• Nearly 10% of fractures having some degree of impaired healing. 4.5%
of tibia fractures exhibit delayed healing and overall 2.5% of tibia
fractures fail to unite (Rockwood)

• MALUNION

• DELAYED UNION

• NONUNION
Malunion
• malunited fracture is one that has healed with the fragments in a non

anatomical position

Causes:

1. Inaccurate reduction

2. Ineffective immobilization

Treatment

• Ilizaroz technique: restoration of: Alignment, Rotation, Length


Delayed Union

• Delayed when healing has not advanced at the average rate for the location
and type of fracture (Btn 3-6 mths)

• Delayed union represents the situation where healing is prolonged compared


to that expected for a given anatomic location.

• Treatment usually is by an efficient cast that allows as much function as


possible can be continued for 4 to 12 additional weeks
Nonunion

• when a minimum of 9 months has elapsed since fracture with no


visible progressive signs of healing for 3 months

• Every fracture has its own timetable (i.e. long bone shaft fracture 6
months, femoral neck fracture 3 months)
Nonunited fractures form two types of pseudoarthrosis:

• Hypervascular or hypertrophic caused by mechanical failures

• Avascular or atrophic caused by biological failures


Hypervascular or Hypertrophic
• Hypertrophic nonunion is defined by abundant bone formation
without bone bridging the fracture site

1. Elephant foot (hypertrophic, rich in callus)

2. Horse foot (mildly hypertrophic, poor in callus)


Avascular or Atrophic

• Atrophic nonunion is defined by the absence of any visible bone


formation on radiographs.

• Causes: infection, compromised nutrition, smoking, medications eg


corticosteroids, and surgeon-controlled factors such as fracture
vascularity.
Nonunion Treatment

The best treatment for non union is prevention (Sir John Charnley)

1. External fixation (i.e. deformity, infection, bone loss)

2. Surgical

• Hypertrophic: stable fixation of fragments

• Atrophic: decortication and bone grafting


•QUESTIONS

•COMMENTS

•THANK YOU

You might also like