16/03/2021

SSEH 1101 School of Human Sciences

Exercise and Sport Science

The Musculoskeletal System &

Movement

Lecture 4a – Bone Injury & Repair: Fractures

Grant Landers

Fracture Healing Process

1. Haematoma formation
After fracture blood vessels in the bone
and periosteum are torn and begin to
haemorrhage

As a result, a haematoma (mass of

clotted blood) forms at the site

Bone cells (deprived of nutrients) begin

to die and the tissue becomes inflamed,
swollen and painful

Fracture Healing Process

2. Granular material formation

(fibrocartilage callus)
Within a few days soft granulation tissue
(soft callus) forms
This is caused by
• Invasion of capillaries
• Phagocyte cells clean up the debris
• Fibroblasts migrate into the site and fill
the area with collagen
• Osteoblasts migrate in to the site from
the periosteum and begin bone
formation

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Fracture Healing Process

3. Hard callus formation

The activity of osteoblasts causes new

trabecular bone to form within the soft
callus

Hard callus formation begins 3-4 weeks

after injury and continues for 2-3 months

Fracture Healing Process

4. Remodelling
Remodelling begins during the hard callus
stage and continues for several months

The excess material around the fracture

site is removed, as well as from within the
medullary cavity

Compact bone is laid down to reform the

shaft walls

Fracture Type

Open Vs Closed

Complete Vs Incomplete

Displaced Vs Non-displaced

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Fracture Type

Greenstick Partial Comminuted

Transverse Oblique Spiral

Fracture Treatment

Fractures are treated by reduction – the realignment of

the broken bone ends

1. Closed reduction the bone ends are coaxed back

into position manually
2. Open reduction the bone ends are secured
together surgically with pins or wires

The limb is then immobilised with a cast or traction to

assist the healing process

Overuse Injury: Tibial pain

There are 2 common causes of

tibial pain
Both, however, result in a condition
called periostitis (inflammation of
the periosteum)

• Tibial Flexing
• Linear Pain

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Overuse Injury: Stress Fracture

Often not a complete break (just

a hairline fracture)
Caused by submaximal repeated
loading – overuse injury

Common sites =
lower leg
& vertebral column

Overuse Injury: Osgood Schlatter

Osgood Schlatter’s disease or Traction Periostitis of the

tibial tuberosity
Very common among young adolescents - pain subsides
with rest

Overuse Injury: Treatment

R. Rest
I. Ice
C. Compression
E. Elevation
R. Referral to medical practitioner
• Physio
• Anti-inflammatory medication
• Modify activity
• Orthotics / change footwear

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Fracture: Avulsion

Avulsion (traction osteochondritis)

Often the bony attachment of the muscle is torn away
rather that the muscle or tendon tearing

Fracture: Epiphyseal

Epiphyseal (growth plate)

Can lead to uneven growth if left untreated
eg. Adams x-rayed 80 little
league pitchers and
found 80 injuries to the
growth plate