Fracture , classification and healing
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It shows a little about fracture, its classification and deals about fracture healing to some extent.
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Fracture , classification and healing
- 1. Fracture, classification and Fracture healing Dr Dipendra Maharjan
- 2. What do you see??? Fig. A Fig. B
- 3. Fracture ο A disruption or break in the continuity of the structure of bone ο Traumatic injuries account for the majority of fractures
- 4. How does a fracture occur? ο Results from ο Injury ο Direct (soft tissue injury is common) ο Indirect ο Twisting ο Compression ο Bending ο tension ο Repetitive stress ο Abnormal weakening
- 5. Classification of fracture ο On the basis of etiology ο On the basis of displacement ο On the basis of communication with external environment ο On the basis of site of fracture ο On the basis of fracture morphology ο On the basis of stability
- 6. β ο On the basis of etiology ο Traumatic ο Atraumatic ο Pathological ο Stress fracture ο Insufficiency fracture Stress Fracture Pathological Fracture Insufficiency Fracture Traumatic Fracture
- 7. Un-displaced Fracture ο On the basis of displacement ο Un-displaced ο Displaced ο Translation ο Angulation ο Rotation ο Length Displaced Fracture
- 8. ο On the basis of communication with external environment ο Closed Fracture ο Open Fracture
- 9. ο On the basis of site of fracture ο Epiphyseal fracture ο Metaphyseal ο Diaphyseal ο Upper third ο Middle third ο Lower third ο Junctional
- 10. ο On the basis of fracture morphology ο Transverse ο Spiral ο Oblique ο Comminuted ο Impacted ο Segmental ο Avulsion
- 11. ο On the basis of stability ο Stable ο Occur when a piece of the periosteum is intact across the fracture ο Unstable ο Grossly displaced ο Periosteum completely torn
- 14. Fracture Healing ο Proliferative physiological state ο Restores the tissue to its original physical and mechanical properties ο Influenced by a variety of systemic and local factors
- 15. Types of Fracture Healing ο Primary Healing (Direct) ο Secondary Healing (Indirect) ο Distraction Osteogenesis
- 16. Primary Healing ο Osteonal Healing ο Involves direct attempt by the cortex to reestablish itself ο Gaps in reduction heal by vessel ingrowth-mesenchymal cells- osteoblasts-osteoclast cutting cones ο Direct contact areas heal by cutting cones allowing passage of vessels ο Resembles normal remodelling ο Occurs only with anatomic reduction & rigid fixation
- 17. Secondary healing ο Enchondral Healing ο Response of periosteum/ external soft tissues ο Recapitulation of embryonic intramembranous ossification and endochondral ossification ο Intramembraneous= peripheral to fracture ο Endochondral= adjacent to fracture ο Motion enhances periosteal response ο External soft tissue forms bridging callus (Periosteal bridging callus)
- 18. STAGES OF FRACTURE HEALING Cortical bone(FROST 1989) ο Inflammation phase ο Stage of Hematoma Formation 1- 2 Days ο Stage of Inflammation 2-7 Days ο Stage of Granulation ο Reparative phase ο Stage of Soft Callus Formation 1- 3 Weeks ο Stage of Hard Callus Formation 3- 6 Weeks ο Remodelling Phase >8. Weeks ο Stage of Remodelling stage (Consolidation) ο Stage of Modelling stage (Remodelling)
- 19. Inflammation Phase ο Hematoma (fibrin clot) ο Macrophages ο Inflammatory leukocytes ο Osteoprogenitor cells ο Hematopoietic cells secrete growth factors ο Granulation tissue
- 20. Reparative phase ο Primary callus response (2 weeks) ο Inflammation triggers cell division and angiogenesis ο Chondrocytes secrete collagen and proteoglycans ο Creates fibrocartilage ο Bone formation ο Soft callus turns to hard callus (lamellar bone)
- 21. Re-modelling phase ο Begins during the middle of the repair phase ο Continues up to years ο Allows the bone to assume its normal configuration ο Wolffβs law ο The stresses on the bone is directly proportional to remodelling
- 22. Growth Factors ο Bone Morphogenic Protein ο Osteoinductive ο Mesenchymal cells to osteoblasts ο Transforming growth factor beta ο Induces mesenchymal cells and osteoblast to produce type II collagen ο Regulates cartilage and bone formation in fracture callus
- 23. ο Insulin like growth factor II ο Promote cell proliferation and matrix synthesis by chondrocytes and osteoblasts ο Responsible for formation of fracture callus ο Platelet derived growth factor ο Stimulate osteoblast or osteoprogenitor cell activity ο Promote bone formation
- 24. Principles of Fracture Healing
- 25. Stability and fracture Healing ο Stability determines strain ο Stain ο Strain is defined as change in fracture gap divided by the fracture gap (ΞL/L) ο Highest fracture site strain is seen in a simple fracture ο Stability ο Absolute stability ο Relative stability ο Strain determines type of healing ο Strain less than 2% results in primary bone healing (endosteal healing). ο Strain 2% to 10% results in secondary bone healing (enchondral ossi cation). ο Strain greater than 10% does not permit bone formation.
- 28. The End!!!