Bone Fracture & Healing Flashcards
What are common fracture ‘types’?
Complete or incomplete (i.e. greenstick fracture in children)
Comminuted - >2 fragments of fracture
Open or closed - open penetrating the skin, risk of infection
Stress - repeated low force injury
Pathological - fracture shouldn’t occur, due to underlying pathology i.e. bony mets, osteoporosis
Displaced - bones not aligned
What are some complications of fractures?
Necrosis - particularly #NOF and scaphoid, empty lacunae can be a sign
Malunion - healing in unacceptable position, can lead to PT osteoarthritis, disability or cosmetic issues
Delayed union - prolonged healing time
Non-union - healing won’t occur with primary management, can lead to pseudo arthritis
Infection - open fractures particularly prone
What are the 4 stages of bone healing?
What is the time line for each?
Bleeding & inflammation - hours to days
Reparative phase 1 - soft callus - days to weeks
Reparative phase 2 - hard callus - weeks to months
Remodelling - months to years
What are the features of bleeding & inflammation phase of bone healing?
Haematoma formation
Release of cytokines by platelets and leukocytes
Formation of granulation tissue
Activation of cells for repair
What are the features of the soft callus of bone healing?
Chondrocytes produce a fibrocartilage callus to unite the ends of the fracture
Periosteum is repaired over the callus
What are the features of the hard callus of bone healing?
Fibrocartilage callus replaced by woven bone via endochondrial ossification process
It is thicker but less strong than the original bone
What are the features of the remodelling phase of bone healing?
Woven bone remodelled to lamellar bone
What factors influence bone fracture healing time?
Reducing a fracture (uniting the ends, i.e. with plates & pins) and fixing the fracture to reduce strain and movement (i.e. splint or cast) will reduce healing time
Infection, smoking or poor blood supply will increase healing time
