Fractures...types and healing of fractures

brief review about fracture , types of fractures ,healing process !!

1. FRACTURES JSS HOSPITAL MYSORE

2. FRACTURES BY :: DR ASHWANI PANCHAL P.G IN ORTHOPAEDICS ORTHOPAEDICS DEPT JSS HOSPITAL, MYSORE

3. 1 INTRODUCTION 2 CLASSIFICATION OF FRACTURE 3 TYPES OF FRACTURE 4 HEALING OF FRACTURE FRACTURE,S- includes

4. > FRACTURE IS DEFINED AS “ BREAK IN THE CONTINUITY OF BONE ”. BREAK DOWN OF BONE IN TWO OR MORE THEN TWO PARTS. Fractures results from :1} injury 2} repetitive stress 3} Abnormal weakness Definition

5. Classification of fractures ON THE BASIS OF AETIOLOGY ON THE BASIS OF DISPLACEMENTS ON THE BASIS OF RELATIONSHIP WITH EXTERNAL ENVIRONMENT

6. [ a. ] Traumatic fracture – sustained due to any trauma… e.g. : # caused by a fall , RSA etc [ b. ] Pathological fracture – it is a # through a bone which has been made weak by some underlying disease e.g :: # through a bone weakened by metastasis,osteoporosis . 1. ON THE BASIS OF AETIOLOGY

7. A. UNDISPLACED # :: fracture with absence of significant displacement B. DISPLACED # : there is displacement of fragment of a bone FACTORS : # force Muscle pull on the # fragment Gravity 2.ON THE BASIS OF DISPLACEMENTS

8. DISPLACED FRACTURE / UNDISPLACED #

9. [a] SIMPLE/CLOSED A fracture not communicating with ext. environment or skin is intact or if there is any wound these are superficial { unrelated to the fracture } 3.ON THE BASIS OF RELATIONSHIP WITH EXTERNAL ENVIRONMENT

10. A fracture with break in the overlying skin and soft tissues ,leading to the fracture communicating with the ext. environment B. COMPOUND/ OPEN #

11. Simple fracture Spiral fracture Transverse fracture Oblique fracture Comminuted fracture Greenstick fracture Segmental fracture Depressed fracture Compression fracture Green stick fracture Hairline fracture Types of fracture

12. Usually caused by directly applied force to fracture site # line is perpendicular to the long axis of the bone Transverse fracture

13. Hairline Fracture In this type of the fracture the crack only extends into the outer layer of the bone but not completely through the entire bone. It is also known as a Fissure Fracture.

14. Caused by violence transmitted through limb from a distance (twisting movements ) Oblique -# line is obligue Spiral -#line runs spirally in more than one plane Spiral or Oblique

15. Two or more bone pieces - high energy trauma # with multiple fragments Comminuated fracture

16. There are two fractures in one bone at different levels SEGMENTAL FRACTURE

17. The fracture in which one side of the bone is broken and the other side is bent . Greenstick Fracture

18. Impacted fractures : broken bone ends are forced into each other Cancellous bone is usually invovled and union is often rapid i Impacted fracture

19. Caused by traction, bony fragment usually torn off by a tendon or ligament. Avulsion fracture

20. FRACTURE HEALING

21. Fracture healing Introduction Fracture healing is a complex process that requires the recruitment of appropriate cells ([[[[fibroblasts, macrophages, chondroblasts , osteoblasts , osteoclasts ]]]]) and the subsequent expression of the appropriate genes [[[[(genes that control matrix production and organization, growth factors, transcription factors]]]]]) at the right time and in the right anatomical location

22. HISTORY In 1975 , Cruess and Dumont proposed that fracture healing may be considered to consist of three overlapping phases: an inflammatory phase, a reparative phase, and a remodeling phase In 1989, FROST proposed the stages of fracture healing five stages. stage of haematoma stage of granulation tissue stage of callus stage of modelling stage of remodelling

23. There are 3 major phases with sub divisions : A .   Reactive Phase: i. Fracture and inflammatory phase. ii . Stage of hematoma formation. iii. Granulation tissue formation. B .   Reparative Phase: iv . Cartilage Callus formation. v . Lamellar bone deposition. C .   Remodeling Phase: vi. Remodeling to original bone contour. 23 STAGES OF FRACTURE HEALING

24. 24 A.REACTIVE PHASE I .Fracture & inflammatory phase : After  fracture the first change seen is the presence of blood cells within the tissues which are adjacent to the injury site. Soon after fracture, the blood vessels constrict, stopping any further bleeding.

25. 25 ii. Stage of Hematoma formation : Within a few hours after fracture, the extravascular blood cells form a blood clot, known as a  hematoma . All of the cells within the blood clot degenerate and die. The fracture hematoma immobilizes & splints the fracture. The fracture haematoma provides a fibrin scaffold that facilitates migration of repair cells.

26. 26 3 iii. Granulation Tissue F ormation : Within this same area, the fibroblasts survive and replicate. They form a loose aggregate of cells, interspersed with small blood vessels, known as  granulation tissue which grows forward, outside and inside the bone to bridge the fracture . They are stimulated by vasoactive mediators like serotonin and histamine.

27. 27 B. REPARATIVE PHASE   iv. Cartilage Callus formation : Days after the # the periosteal cells proximal to the fracture gap and fibroblasts develop into  chondroblasts  which form hyaline cartilage. The periosteal cells distal to the fracture gap develop into osteoblasts which form woven bone. These 2 tissues unite with their counterparts and culminate into new mass of heterogenous tissue called F racture Callus restoring some of its original strength.

28. 28 C. REMODELLING PHASE vi. Remodelling to original bone contour : The remodeling process substitutes the trabecular bone with compact bone . The trabecular bone is first resorbed by osteoclasts, creating a shallow resorption pit known as a " Howship's lacuna ". Then osteoblasts deposit compact bone within the resorption pit . Eventually, the fracture callus is remodelled .

29. HEALING OF CANCELLOUS BONES The healing of fracured cancellous bone follows a different pattern The bone is of uniform spongy texture and has no medullary cavity , so that there is large area of contact between the trabeculae Union can occur directly between the bony surfaces without having to pass through the stage of callus formation Following haematoma nd granulation formation,mature osteoblasts lay down woven bone in the intercellular matrix,and the two fragments thus unite.

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