1. D SRINATH
FINAL YEAR M.B.B.S

2.  FRACTURE
 Disruptions of bone tissue
 FRACTURE HEALING
 It is a complex process that requires recruitment of
appropriate cells(fibroblasts, macrophages,
chondroblasts, osteoblasts, osteoclasts) and
subsequent expression of the appropriate genes(genes
that control matrix production and organisation,
growth factors, transcription factors)

3.  Bone regeneration is the appropriate term
 Bone healing is unique that there is no scar at the
place of impact
THREE PHASES OF HEALING
Inflammatory
phase
Reparatory
phase
Remodelling
phase

5. INFLAMMATORY PHASE
PMN macrophages  angiogenesis
Vessels dilate Acute edema
Inflammatory mediators(TGFβ, acidic fibroblast growth factor, basic fibroblast growth factor, PDGF)
Dead cells, platelets, injured cells
Hematoma formation ( fibrin in hematoma attracts reparative cells)
Fracture of the bone destroys the cells, blood vessels, bone matrix, periosteum and muscles

7. REPARATORY PHASE
enchondral ossification , hard callus enlargement, increase in the stability of fractured
fragments
Hard callus – the bone that is formed in the periphery of the callus by intramembranous
bone formation
Soft callus – forms in the central region of the fractured bone
Primarily of cartilage and fibrous tissue
Callus – comprises fibrous tissue,cartilage , woven bones
After inflammation subsides fibroblasts and chondrocytes appear in the site leading to
callus formation

8. REMODELLING PHASE
Callus diameter decreases in size
The medullary canal is reconstituted
Woven bone is converted into lamellar bone

9. Methods of fracture healing

10. INDIRECT
 This is most common method of fracture healing
 POP is based on this

11. Hunter’s staging
• from the moment of impact to the fracture of the bone
Stage of impact
• the cells involved in the callus formation is induced by
BMP, low oxygen tension, bioelectric
Stage of induction
• hemorrhage, angiogenesis, cellular infilatration
Stage of inflammation

12. • blood from torn vessel collects
• Hematoma formation
• organised with fibrous tissue, cartilage
Stage of hematoma
• intercellular matrix formation with calcium salt deposition
stage of callus
• woven bone to lamellar bone
• haversion remodelling
• normal cortical bone structure attained
stage of remodelling

13. FROST STAGING
stage of hematoma
stage of granulation tissue
stage of callus
stage of remodelling
stage of modelling

14. DIRECT BONE HEALING
 healing by primary intention
 no callus formation
 anatomically reduced and fixed
 open procedure with plates and screws
 healing occurs by osteon - osteon hook up by direct
haversion remodelling
 Osteoclasts  cut the bone, osteoblasts -paste the
bone

17. DISTRACTION HISTEOGENESIS
healed by gradual distraction of
osteomies
clinical union – fracture site is stable
and pain free
radiological union – x ray shows bone
trabeculae and cortical bone at fracture
site

19. FACTORS INFLUENCING
FRACTURE HEALING
 SYSTEMIC FACTORS
 Age
 Children heals earlier than adults
 Sex
 same
 Activity level
 Adequate immobilisation
 Nutrional status

20.  Hormone factors
 Growth hormone
 Corticosteroids
 Sex hormones
 Thyroid and parathyroid
 calcitonin
 Diseases
 DM
 Anemia
 Scabies
 neuropathies
 Vitamin deficiencies
 A,D,C,K

21.  Drugs and other substances
 Nsaids
 Phenytoin
 Tetracyclines
 Nicotine alcohol
 Hypoxia
 Systemic growth factors
 Environmental temperature
 CNS trauma

22. LOCAL FACTORS
 Factors independent of injury, treatment
and complication
 Type of bone – flat and cancellous bone quick
healing
 Abnormal bones – radiation necrosis,
infection, tumors

24. Factors depending on injury
 Degree of local damage – compound #,
comminute#, velocity of injury, ,
 type and location
 pattern of # - spiral<oblique<transverse
 loss of bone
 soft tissue interposition

25. Factors depending on treatment
 Implants
 Extent of surgical trauma
 Degree of rigidity of external and
internal fixation
 Extent of contact between fragments

26. Factors associated with
complications
 Infection
 Venous stasis
 Metal allergy

27. Failure of fracture healing
 Delayed union
 Non union(hypertrophic and atrophic)
 Fibrous union