LOCO Fractures and Healing

Question 1

What are the three phases of fracture healing and when does each occur

Answer 1

Inflammatory - Immediate
Reparative - weeks
Remodelling - months

Question 2

What is involved in the inflammatory phase of fracture healing

Answer 2

• A haematoma forms at the fracture ends
• This prevents further bleeding as well as provides structural and biochemical support for the influx of inflammatory cells, fibroblasts and chondroblasts as well as the ingrowth of capillaries.
• This usually takes around a week and results in a primary callus which is non mineralised

Question 3

What is involved in the reparative phase of fracture healing

Answer 3

• Primary callus is transformed into a fibrocartilaginous callus by unvasion of fibroblasts and osteogenic cells
• Fibrocartilaginous callus is then transformed into the bony callus by the activation of osteoprogenitor cells after around 3 weeks lasting for 3-4 months
• Osteoprogenitor cellsalso lay down woven bone to stabilise the fracture site

Question 4

What is involved in the remodelling phase of fracture healing

Answer 4

• Represents the gradual formation of compact cortical bone which has greater biomechanical properties allowing for the reduction in the width of the callus
• osteoclasts remodel woven bone into compact and trabecular bone
• In some cases (more likely in younger people) it results in almost perfect healing and there is often no trace of a fracture line on xrays
• However, if the alignment is not perfect , a residual deformity will occur

Question 5

What is garden classification and how many stages are there

Answer 5

Most common classification of NoF fractures, can predict the development of AVN. There are 4 stages with 1 and 2 being stable fractures and 3 and 4 being unstable fractures that require arthroplasty

Question 6

What are the different stages of Garden classification

Answer 6

Stage I: Undisplaced incomplete fracture including valgus impacted fractures
Stage II: undisplaced complete fracture
Stage III: Incompletely displaced complete fracture
Stage IV: Completely displaced displaced fracture

Question 7

Why are elderly people more likely to fall?

Answer 7

• Chronic health conditions causing dizziness or loss of consciousness
• Impairments such as loss of vision, muscle weakness, slowing of reflexes
• Illnesses that can affect balance, such as labyrinthitis

Also external factors such as their home environment

Question 8

What are the most common causes of falls in the elderly?

Answer 8

• Wet or recently polished floors
• Dim light
• Rugs or carpets that are not properly secured
• Reaching for storage areas
• Stairs

-In men-> falling from a ladder during maintenance work