P R E S E N T E D B Y

PRATHMA

B P h T 2 N D Y E A R

P G I M E R

FACTORS AFFECTING

BONE FRACTURE

HEALING

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I N T R O D U C T I O N

• A bone fracture is a medical condition in which there is a break in the continuity of the bone.

• It is sometimes abbreviated FRX or Fx, Fx, or #.

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CAUSES OF BONE FRACTURE

Fractures occur when bone cannot withstand those outside forces. Broken bones hurt for a variety of reasons including:

• The nerve endings that surround bones contain pain fibers and these fibers become irritated when the bone is broken or bruised.

• Broken bones bleed, and the blood and associated swelling (edema) causes pain.

• Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain.

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C L A S S I F I C AT I O N

1.     Complete fracture

2.     Incomplete fracture

Based On The Extent Of The Break

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• 1.     Open fracture(compound fracture)• 2.     Closed fracture(simple fracture)

C L A S S I F I C A T I O N

Based On The Extent Of Soft-tissue Damage

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• 1. A stable fracture (non displaced fracture)• 2. An unstable fracture (displaced fracture)

C L A S S I F I C A T I O N

Based On The Anatomic Alignment Of The Bone

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C L A S S I F I C A T I O N

Based On The Direction Of The Fracture Line

7.     Compression fracture

2.     Transverse fracture1.     Greenstick fracture

3.     Oblique fracture

4.     Spiral fracture 5.     Comminuted(fragmented) fracture

6.     Impacted fracture

Pain

Although bone tissue itself contains no nociceptors, bone fracture is very painful for several reasons:

• Breaking in the continuity of the periosteum, with or without similar discontinuity in endosteum, as both contain multiple nociceptors.

• Edema of nearby soft tissues caused by bleeding of torn periosteal blood vessels evokes pressure pain.

• Muscle spasms trying to hold bone fragments in place

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1) A hematoma is formed. Blood vessels are ruptured when bone breaks. As a result, a blood-filled swelling forms. Bone cells are deprived of nutrition and die.

B O N E H E A L I N G

The process of fracture/bone healing:

2) the break is splinted by a fibrocartilage callus. Connective tissue cells of various types form a mass of Repair tissue called fibrocartilage callus (containing cartilage matrix, bony matrix, and collagen fibers) Which act to “splint” the broken bone, closing the gap.

B O N E H E A L I N G

3) A bony callus is formed. Osteoblasts and osteoclasts migrate tothe area and multiply. Thus the fibrocartilage callus is graduallyreplaced by one made of spongy bone, known as the bony callus.

B O N E H E A L I N G

4) Lastly, bone remodeling occurs. Over the next few weeksto months, the bony callus is remodeled in response to mechanicalstresses placed on it, so that it forms a strong permanent (bone) patch at the fracture site.

B O N E H E A L I N G

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TREATMENT OF BONE FRACTURE

• The types of treatment include: • closed reduction • traction • open reduction and internal fixation • external fixation • casts and splints and • functional casts or braces

Therapeutic Implications for Treating Fractures

Active ROM exercises to joints above and below immobilized region

Resistive ROM exercises to muscle groups that are not immobilized

Once the cast or immobilization device has been removed:

gentle but progressive resistance exercises of all immobilized joints

evaluate strength of joint(s) and compare to non-injured counterparts

return to vigorous activity only after strength discrepency < 15%

Factors Enhancing Bone Healing

Youth

Early Immobilization of fracture fragments

Maximum bone fragment contact

Adequate blood supply

Proper Nutrition

Vitamines A&D

Weight bearing exercise for long bones in the late stages of healing

Adequate hormones:

growth hormone

thyroxine

calcitonin

Factors Inhibiting Bone HealingAge

Fractured Femur Healing Timeinfant: 4 weeks

teenager: 12 to 16 weeks

60 year old adult: 18 to 20 weeks

Extensive local soft tissue trauma

Bone loss due to the severity of the fracture

Inadequate immobilization (motion at the fracture site)

Infection

Avascular Necrosis

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C O N C L U S I O N

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