Fracture healing

Question 1

The 3 A’s of assessment of repair and healing

Answer 1

1.Alignment and reduction (or apposition)
2. Apparatus
3. Activity

Question 2

Alignment and reduction

Answer 2

Alignment- how the bone is lined up; should be pointed in normal direction
*can check by drawing lines across the joints

Reduction- how well the pieces fit together
-good=barely see fracture line

Question 3

Apparatus analysis

Answer 3

-repair technique and how it will work for the repair?
*are materials adequate for the repair!

Question 4

Activity

Answer 4

-how fracture is healing?
-how is the patient using the limb?

Question 5

What effects fracture healing?

Answer 5

1. nature of fracture (eg. soft tissue impacts, gun shot wounds, periosteum intactness)
2. location of fracture (metaphysis has more blood supply so easier to heal than diaphysis)
3. Bone that is fractured
   -more muscle attachments +blood supply = greater healing (eg. humerus better healing than tibia)
4. Degree of soft tissue disruption = disruption of blood supply so harder to heal
5. Strain and motion at fracture site- too much tension = bad; little axial tension or compression= good; too little strain (disuse)=bad; torsion always bad!!)
6. Type of healing affects return of speed and strength
7. limb use (use it or lose it!)
8. species (a bird vs a horse vs a cat)
9. Age

Question 6

Guidelines for uncomplicated fracture healing based on age

Answer 6

2-5mths of age = 2-4 weeks

6-12mths of age= 4-8wks

Adult= 6-10wks

Elderly= 12-16wks

Question 7

Radiographic union: primary healing

Answer 7

Direct healing where fracture line disappears

Question 8

Radiographic union:secondary healing

Answer 8

Indirect healing where bridging callus occurs at least 3 out of 4 cortices