Activity 2 Sean Eric Tecson CON-3-A1 Bone healing stages

2012-10-01

hematoma formation

Hematoma formation occurs during the first 1 to 2 days after fracture. It develops from torn blood vessels in the periosteum and adjacent muscles and soft tissue. Disruption of blood vessels also leads to death of bone cells at the fracture site. In 2 to 5 days, the hemorrhage forms a large blood clot. Neovascularization begins peripheral to the blood clot. By the end of the first week, most of the clot is organized by invasion of blood vessels and early fibrosis. As the result of hematoma formation, clotting factors remain in the injured area to initiate the formation of a fibrin meshwork

This stage starts around the first week and ends at the 2nd or 3rd weekAs new capillaries infiltrate the hematoma at the fracture site, it becomes organized into a form of granulation tissue, called procallus. Fibroblasts from the periosteum, endosteum, and red bone marrow proliferate and invade the procallus. The fibroblasts produce a fibrocartilaginous soft callus bridge that connects Fibrocartilaginous the bone fragments. Although this repair tissue usually reaches its maximum girth at the end of the Callus Formation second or third week, it is not strong enough for weight bearing.

Bony Callus Formation

Ossification and formation of bony callus represent the deposition of mineral salts into the callus. This stage usually occurs during the third to fourth week of fracture healing and is prominent 2 to 3 months after the injury. Continued migration and multiplying of osteoblasts and osteocytes turns the fibrocartilaginous callus into bony callus. The fracture site feels firm and immovable and appears united on the radiograph. At this point, it is safe to remove the cast and allow increased weight bearing.

Remodeling

During this period, the excess material on the outside of the bone shaft and within the medullary cavity is removed and compact bone is laid down to reconstruct the shaft. The final structure of the remodeled area resembles that of the original unbroken bone; however, a thickened area on the surface of the bone

Compartment syndrome

Injury

blood vessel congestion

Hypoxia

edema

ishcema

Muscle necrosis and nerve damage

Atrophy and loss of function

Interventions Any restricting devices such as casts, splints, or dressings must besplit, loosened, or removed. Do not apply ice or elevate the extremity above the level of the heart, as these actions may further impair circulation. If removing restrictive devices does not lessen the pressure, then the physician will

Activity 2 Sean Eric Tecson CON-3-A1

2012-10-01

perform a fasciotomy. An incision is made into the fascia to relieve pressure. This incision will be left open until pressure within the compartment has been resolved During this time, the wound is covered with moist, sterile dressings.