Fracture Healing, Complications & factors promotes the fracture healing.pptx

A brief overview of fracture healing in small animals and the factors that promotes the healing process

1. Fracture Healing, Complications & factors promotes the fracture healing Presented By: Surgery Group 2 Presented To: Dr.Asad Manzoor

2. Fracture healing Goals of fracture healing Encourage Healing Restore function Cosmetically acceptable appearance Factors influence the fracture healing Biologic Events Mechanical Events

3. Blood supply of healing long bones Blood supply to bone. A, Normal bone. B, Immature bone. C, Fractured bone ( extraosseous blood supply). D, Healing bone.

4. Effect of different fixation devices on circulation to fracture bone

5. Fracture Healing

6. Phases of fracture healing Reactive phase Inflammatory phase Granulation tissue formation R eparative phase Cartilage callus formation Lamellar bone deposition Trabecular bone formation Remodelling phase Trabecular bone  compact bone

7. Time Distribution of different phases of fracture healing

8. Inflammatory phase Hematoma formation soon after the fracture

9. Reparative phase

10. Reparative + Remodeling phase

11. Collagen & muco-polyscharides level during the fracture healing

12. Indirect bone healing Hematoma & granulation tissue formation Granulation tissue replaced by fibrous tissue & fibrocartilage Local resorption of mineralized tissue Vascularization of resorption cavity Formation of lamellar bone in this cavity Remodeling

13. Indirect bone healing

14. Indirect bone healing Indirect bone healing A-Bone resorption B-Periosteal callus formation C-Mineralization of fibrocartilage D-Bone remodeling

15. Direct bone healing Fracture having small gaps (150-300µm) between fractured ends Gaps filled with the network of fibrous tissue Remodeling of bone union within 7-8 weeks + longitudinal reconstruction of fracture site Radiographicaly slowly increasing density of fracture line without bridging periosteal & endosteal callus

16. Direct Bone Healing Direct bone healing Simultaneous union and reconstruction (A , B) Gap fills with fibrous bone ( C) H aversian remodeling (D ).

17. Direct Bone Healing Fracture healing in a transverse radial fracture in mature dog treated with bone plate .

18. Intra-membranous B one Healing Direct differentiation of mesenchymal cells in to osteoblasts Bone bridging between comminuted bone fragments after biologic fixation technique Periosteal callus is smaller in comminuted fracture Resorption of woven bone & formation of lamellar bone Remodeling

19. Intra-membranous Bone Healing A, Comminuted fractures fixed with biologic techniques of indirect reduction, major segment alignment, and optimal stabilization appear to heal with a combination of direct differentiation of mesenchymal cells to osteoblasts and endochondral ossification. B, The fracture site fills with endosteal and bridging callus. C, Resorption of woven bone and formation of lamellar bone at the fracture sites result in remodeling of bony callus to cortical bone.

20. Intra-membranous Bone Healing A, Fracture healing in comminuted nonreducible radial fracture treated with closed reduction and external fixation . B and C, Radiographically endosteal bone appears first, followed by bone bridging between fragments with minimal periosteal callus formation . D, Bone remodeling occurs after the fracture lines are bridged.

21. Trabecular Bone Healing Increase osteoblastic activity on either side of fracture New bone deposit on existing trabeculae Fracture gap filled with woven bone Radiographicaly formation of one or two dense band at fracture site

22. Trabecular Bone Healing Metaphyseal fracture healing after a tibial plateau leveling osteotomy, which is well stabilized showing trabecular bone healing.

23. COMPLICATIONS IN FRACTURE HEALING Delayed union (healing slower than normal) Non-union (arrested fracture repair process) Osteomyelitis (inflammatory condition of bone & medullary canal) Mal-union (anatomic bone alignment not achieved)

24. Delayed Union Delayed healing after 6 weeks of bone marrow injection COMPLICATIONS IN FRACTURE HEALING

25. Non-union of Femur Radiograph of dog with hypertrophic nonunion of femur. Notice formation of large periosteal callus that cannot bridge the fracture. The fracture was inadequately stabilized with an IM pin and cerclage wires . COMPLICATIONS IN FRACTURE HEALING

26. Non-union VS Mal-union COMPLICATIONS IN FRACTURE HEALING

27. Osteomyelitis Infectious periostitis. A subtle, linear periosteal reaction ( arrows ) can be seen along the lateral aspect of the third toe proximal phalanx. Note the associated soft tissue increase in volume and density affecting the third and fourth toes COMPLICATIONS IN FRACTURE HEALING

28. Factors promotes the fracture healing The factors that promotes fracture healing are: Growth hormones Thyroid hormone Calcitonin Insulin Vitamin K Vitamin C Vitamin D Immobilization

29. Factors promotes the fracture healing Anabolic steroids Young age Nutrition status Cerament Electric current Physical exercise Minerals High protein diet

30. Suggested Reading Griffon DJ: Fracture healing. In Johnson AL, Houlton JEF, Vannini R, editors: AO principles of fracture management in the dog and cat, Thieme , NY, 2005, AO Publishing, pp. 73-97. Johnson AL, Egger EL, Eurell JC, et al: Biomechanics and biology of fracture healing with external skeletal fixation, Compend Cont Educ Pract Vet 20:487, 1998 . Wilson JW: Blood supply to developing, mature and healing bone. In Sumner-Smith G, (editor): Bone in clinical orthopedics , ed 2, Thieme , New York NY, 2002, AO Publishing, p. 23.

31. Suggested Reading Budsberg SC: Osteomyelitis, In Johnson AL, Houlton JEF, Vannini R, editors: AO principles of fracture management in the dog and cat, Thieme NY, 2005, AO Publishing. Johnson AL: Corrective osteotomies, In Johnson AL, Houlton JEF, and Vannini R, editors: AO principles of fracture management in the dog and cat, Thieme , NY, 2005, AO Publishing.

32. Any question??????

33. Topic for Performance: Pinning of long bone