Fractures and Bone Healing (2)

8/12/2019 Fractures and Bone Healing (2)

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Fractures andBone Healing


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Statistics

Fractures of extremities most common More common in men up to 45 years of

age More common in women over 45 years of age

Before 75 years wrist fractures (Colles)most common After 75 years hip fractures most common


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Types of fractures

Magnitude and direction of forceClosed

Bone fragments do not pierce skinOpen/compound

Bone fragments pierce skin

Displaced or undisplaced


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Transverse fracture

Usually caused by directly applied force tofracture site


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Spiral or Oblique

Caused by violence transmitted throughlimb from a distance (twisting movements)


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Greenstick

Occurs in children: bones soft and bendwithout fracturing completely


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Crush fracturesFracture in cancellous bone: result ofcompression (osteoporosis)


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Burst fractureOccurs in short bones, e.g. vertebra fromstrong direct pressure such as impactionof disc.


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Avulsion fractureCaused by traction, bony fragment usually torn off by atendon or ligament.What muscle group attaches to this bony prominenceand what nerve also runs in close proximity?Forearm flexors (common flexor origin) ulnar nerve


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Fracture dislocation/subluxation

Fracture involves a joint: results inmalalignment of joint surfaces.


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Impacted fracture

Bone fragments are impacted into eachother.


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Comminuated fracture

Two or more bone pieces - high energytrauma


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Comminuated fractures can requireserious hardware to repair.


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Stress fracture

Abnormal stress on normal bone (fatiguefracture) or normal stress on abnormalbone (insufficiency fracture).


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Functions of the X-ray

Localises fracture and number of fragmentsIndicates degree of displacementEvidence of pre-existing disease in boneForeign bodies or air in tissuesMay show other fracturesMRI, CT or ultrasound to reveal soft tissue

damage


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How to HandleFractures

ReductionOpen reduction

Allows very accurate reduction Risk of infection

Usually when internal fixation isneededManipulation

Usually with anaesthesiaTraction

Fractures or dislocation requiring slo


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Holding the reduction

4-12 weeksExternal fixation

Internal fixation Intermedually nails, compressionplates

Frame fixation


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External fixation

Used for fractures that are too unstable fora cast. You can shower and use the handgently with the external fixator in place.


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Frame fixation

Allows correction of deformities by movingthe pins in relation to the frame.


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Internal fixation


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Bone Healing

1. Fracture hematoma blood from brokenvessels forms a clot.

6-8 hours afterinjury

swelling and

inflammation to deadbone cells at fracturesite


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2. Fibrocartilaginous callus(lasts about 3 weeks (upto 1st May))

new capillariesorganise fracturehematoma into

granulation tissue -procallus Fibroblasts andosteogenic cells invadeprocallus.

Make collagen fibreswhich connect endstogether

Chondroblasts begin toproduce fibrocatilage,


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3. Bony callus

(after 3 weeks andlasts about 3-4months)

osteoblasts makewoven bone.


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4. Bone Remodeling

Osteoclastsremodel wovenbone into

compact boneand trabecularbone

Often no traceof fracture lineon X-rays.


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Fractures and Bone Healing (2)

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