Fractures and

Bone Healing
Response to Mechanical Stress
Wolff’s law – a bone grows or remodels in
response to the forces or demands placed
upon it
 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
 In elderly wrist fractures (Colles’) and hip
fractures are the most common
 Fractures
A fracture is any break in a
structural continuity of bone.

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 Describing fracture (Salter )
 1. site; EMD
 2. extent; in/complete
 3. configuration; simple, comminuted
 4. relation between fragmen; translation,
impacted, exc
 5. relation environmet; open or close
 6. complication; local or systemic, exc
 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
 Pott’s -- distal fibular fracture
 Colles’s -- 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
 Fracture in 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
Fracture treatment (Apley Solomon)
Close fracture :
Reduction ; close or open
Retention ; sustained traction, cast,
functional brace, in or external fix
Rehabilitation; active or passive
Open fracture :
Splint and cover wound with sterile
dressing
Antibioic and amti tetanus
Classify the fracture (Gustillo And)
Infection prevention :
Antibiotic
Wound debridement
Stabilize fracture
Early defenitive wound cover
 Open Fracture Classification
Gustilo and Anderson
 Type I
 Clean wound <1 cm in length
 # is simple, transverse or oblique with little
comminution
 Type II
 Laceration >1cm without extensive soft tissue
damage, flaps or avulsions
 Type III
 Extensive soft tissue damage, crushing or a traumatic
amputation
 Subtypes 3A, 3B, 3C
 Open Fracture Classification
 Type 3 subtypes
 3A: Adequate soft tissue coverage
 3B: Inadequate soft tissue coverage
 3C: Arterial injury requiring repair

3B
 Open Fracture Classification

Type I Type I

Type IIIb Type IIIc

 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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 Hematoma formation
 Torn blood vessels
hemorrhage
Hematoma
 A mass of clotted
blood (hematoma)
forms at the
fracture site
 Site becomes
swollen, painful,
and inflamed
 3-4 hours

1 Hematoma formation
 The fibrocartilaginous callus
forms
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
 Fibrocartilagino
us callus forms
 Granulation External
callus
tissue (soft
callus) forms a
few days after New
the fracture Internal
blood
vessels
 Capillaries grow callus
(fibrous
into the tissue tissue and
cartilage)
Spongy
bone
and phagocytic trabeculae

cells begin 2 Fibrocartilaginous

cleaning debris callus formation
 Bony callus formation
 New bone trabeculae
appear in the Bony
fibrocartilaginous callus callus of
spongy
 Fibrocartilaginous callus bone

converts into a bony

(hard) callus
 Bone callus begins 3-4
weeks after injury, and
continues until firm union
is formed 2-3 months
later 3 Bony callus
formation
 Bone remodeling
 Excess material on
the bone shaft
exterior and in the
medullary canal is
removed
 Compact bone is Healing
laid down to fracture

reconstruct shaft
walls
4 Bone remodeling