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
5. ON THE BASIS OF AETIOLOGY
2. ON THE BASIS OF
DISPLACEMENTS
ON THE BASIS OF RELATIONSHIP
WITH EXTERNAL ENVIRONMENT
1.
3.
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.
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
8.
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 }
10.
A fracture with
break in the
overlying skin and
soft tissues ,leading
to the fracture
communicating
with the ext.
environment
12.
Usually caused by directly applied force to
fracture site
# line is perpendicular to the long axis of the
bone
13. 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
15.
Two or more bone pieces - high energy
trauma
# with multiple fragments
18. Impacted fractures:
•
broken bone ends are forced into each other
•Cancellous bone is usually invovled and union is often rapid
Impacted fracture
21.
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.
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.
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24.
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.
24
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.
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26. iii. Granulation Tissue Formation:
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.
26
27.
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 Fracture Callus
restoring some of its original strength.
27
28.
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.
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29.
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.
