Bone Healing

Question 1

primary bone healing?

Answer 1

Most of the time we are not aware we have microfractures and they occur in our bones every day. Bone repairs these microfractures itself through primary fracture healing and undergoes repair

Question 2

secondary bone healing?

Answer 2

When we have larger fractures we use secondary fracture healing. These breaks will damage the soft tissues and cause haematoma. There are four stages: inflammation. Soft callus, hard callus and remodeling.

Question 3

what are stress fractures?

Answer 3

Microfractures can result in symptomatic fractures when the production of fractures exceeds repair. These are stress fractures that will potentiate into secondary healing by callus formation. These are common in ballet dancers and soldiers who march long distances.

Question 4

The commonest areas for paediatric fractures are areas of rapid growth - which are where?

Answer 4

distal humerus, distal radius, and the growth plate

Question 5

what is a green stick fracture?

Answer 5

children’s’ bone is less brittle can undergo more plastic deformation than in adults ie it can bend and stay bent without breaking in two

Question 6

Osteoporosis means less force is required to damage bones:

common sites?

Answer 6

vertebral fractures,
wrist fractures
and
hip fractures.

Question 7

In osteoporosis patients a fall on outstretched hand - name?

lead to what type of fracture in hand?

what other fractures can it lead to?

Answer 7

FOOSH fracture

comminuted distal radius fracture

distal humerus
clavicle fracture

Question 8

Types of fracture:

• transverse?
• spiral?
• oblique?
• comminuted?
• segmental?

Answer 8

• transverse - horizontal
• spiral - twist
• oblique - diagonal
• comminuted - lots of pieces
• segmental - broken in 2 places (3 bits of bone)

Question 9

what is non-union?

2 types:

hyperytrophic non union?

atrophic non union?

Answer 9

absence of fracture healing within the expected period of time.

hypertrophic non union = callus formation but fracture line persists

atrophic non union = no callus formation at fracture site at al

Question 10

Perren’s strain theory

The degree of strain at the fracture site governs dictates the type of tissue that forms between the fracture fragments (thus the type of healing that occurs).

• further the strain (greater the change in length/ stretched more)

what healing occurs with:

• high strain
• low strain

Answer 10

high strain = callus formation (secondary bone healing)

low strain = bone forms ( primary bone healing)

Question 11

with plate fixation - what type of healing occurs?

with intramedullary nails - what type of healing occurs?

Answer 11

primary

secondary

Question 12

Four principles of Fracture Mx ?

Answer 12

1) Manage soft tissue injury (wounds/compartment syndrome)
2) reduce (directly - open reduction or indirectly - manipulation)
3) maintian (POP, internal/external fixation)
4) rehabilitate (phsyio)