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Fractures and

Bone Healing
H Biology II
Adapted 2014-2015
Response to Mechanical Stress
Wolffs law a bone grows or remodels in
response to the forces or demands placed
upon it
Observations supporting Wolffs law
include
Long bones are thickest midway along the
shaft (where bending stress is greatest)
Curved bones are thickest where they are
most likely to buckle
Response to Mechanical Stress
Trabeculae form along lines of stress
Large, bony projections occur where
heavy, active muscles attach
Response to Mechanical Stress
Statistics
Fractures of extremities most common
More common in men up to 45 years of age
More common in women over 45 years of age
Before 75 years wrist fractures (Colles) most
common
After 75 years hip fractures most common
Fractures
A fracture is any break in a bone.
Fracture repair involves formation of a clot called
a fracture hematoma, organization of the
fracture hematoma into granulation tissue called
a procallus (subsequently transformed into a
fibrocartilaginous [soft] callus), conversion of the
fibrocartilaginous callus into the spongy bone of
a bony (hard) callus, and, finally, remodeling of
the callus to nearly original form.

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Bone Fractures (Breaks)
Bone fractures are classified by:
The position of the bone ends after fracture
The completeness of the break
The orientation of the bone to the long axis
Whether or not the bones ends penetrate the
skin
Common Types of Fractures

Magnitude and direction of force are


determining factors in type of fracture.
Closed
Bone fragments do not pierce skin
Open/compound
Bone fragments pierce skin
Displaced or undisplaced
Common Types of Fractures
Comminuted bone fragments into three
or more pieces; common in the elderly
Spiral ragged break when bone is
excessively twisted; common sports injury
Depressed broken bone portion pressed
inward; typical skull fracture
Compression bone is crushed; common
in porous bones
Common Types of Fractures
Epiphyseal epiphysis separates from
diaphysis along epiphyseal line; occurs
where cartilage cells are dying
Greenstick incomplete fracture where
one side of the bone breaks and the other
side bends; common in children
Common Types of Fractures
Common Types of Fractures
Common Types of Fractures
Common Types of Fractures

Named for shape or position of fracture line


Common types of fracture
Potts -- distal fibular fracture
Colless -- distal radial fracture
stress fracture -- microscopic fissures from
repeated strenuous activities
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Transverse fracture
Usually caused by directly applied force to
fracture site
Spiral (Oblique)
Caused by violence transmitted through
limb from a distance (twisting movements)
Greenstick
Occurs in children: bones soft and bend
without fracturing completely
Compression (Crush) fractures
Fracturein cancellous bone: result of
compression (osteoporosis)
Burst fracture
Occurs in short bones, e.g. vertebra from
strong direct pressure such as impaction
of disc.
Avulsion fracture
Caused by traction, bony fragment usually torn off by a
tendon or ligament.
What muscle group attaches to this bony prominence
and what nerve also runs in close proximity?
Forearm flexors (common flexor origin) ulnar nerve
Fracture dislocation/subluxation
Fracture involves a joint: results in
malalignment of joint surfaces.
Impacted fracture
Bone fragments are impacted into each
other.
Comminuated fracture
Two or more bone pieces - high energy
trauma
Comminuated fractures can require
serious hardware to repair.
Stress Fracture
Abnormal stress on normal bone (fatigue
fracture) or normal stress on abnormal
bone (insufficiency fracture).
Functions of the X-ray
Localizes fracture and number of fragments
Indicates degree of displacement
Evidence of pre-existing disease in bone
Foreign bodies or air in tissues
May show other fractures
MRI, CT or ultrasound to reveal soft tissue
damage
Repair/Healing of Bone
Healing is faster in bone than in cartilage due to
lack of blood vessels in cartilage
Healing of bone is still slow process due to
vessel damage
Clinical treatment
closed reduction = restore pieces to normal position
by manipulation
open reduction = realignment during surgery

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How to Handle Fractures

Reduction
Open reduction
Allows very accurate reduction
Risk of infection
Usually when internal fixation is needed
Manipulation
Usually with anesthesia
Traction
Fractures or dislocation requiring slow therapy
Fracture Fixation
4-12 weeks
External fixation
Internal fixation
Intermedually nails, compression plates
Frame fixation
External fixation
Used for fractures that are too unstable for
a cast. You can shower and use the hand
gently with the external fixator in place.
Frame fixation
Allows correction of deformities by moving
the pins in relation to the frame.
Internal fixation
Repair of
a
Fracture

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Stages
Hematoma
in the Healing of a Bone
formation Fracture Hematoma
Torn blood vessels
hemorrhage
A mass of clotted
blood (hematoma)
forms at the
fracture site
Site becomes
swollen, painful,
and inflamed 1 Hematoma formation

3-4 hours
Stages in the Healing of a Bone
Fracture
The fibrocartilaginous callus forms when:
Osteoblasts and fibroblasts migrate to the
fracture and begin reconstructing the bone
Fibroblasts secrete collagen fibers that
connect broken bone ends
Osteoblasts begin forming spongy bone
Osteoblasts furthest from capillaries secrete
an externally bulging cartilaginous matrix that
later calcifies
Stages in the Healing of a Bone
Fibrocartilagino
us callus forms Fracture
External
Granulation callus

tissue (soft
callus) forms a
few days after New
the fracture Internal
blood
vessels
callus
Capillaries grow (fibrous
tissue and Spongy
into the tissue cartilage) bone

and phagocytic trabeculae

cells begin 2 Fibrocartilaginous


callus formation
cleaning debris
Stages in the Healing of a Bone
Fracture
Bony callus formation
Bony
New bone trabeculae callus of
appear in the spongy
bone
fibrocartilaginous callus
Fibrocartilaginous callus
converts into a bony
(hard) callus
Bone callus begins 3-4
weeks after injury, and
continues until firm union
3 Bony callus
is formed 2-3 months formation
later
Stages in the Healing of a Bone
Bone remodelingFracture
Excess material on
the bone shaft
exterior and in the
medullary canal is
removed Healing
fracture
Compact bone is
laid down to
reconstruct shaft
walls 4 Bone remodeling