Evaluation of Femoral Bone Fracture Healing in Rats by the ...
Bone Fracture and healing
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Transcript of Bone Fracture and healing
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Bone Fracture and healing
Prof. Mamoun KremliAlMaarefa College
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Definition of Fracture A break in the continuity bone
Often associated with soft tissue injury Soft tissue injuries might be more serious
than the fracture
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Etiology Motor Vehicle Accident Fall Sport injuries Vigorous Exercise Bone Diseases
Osteoporosis Osteomyelitis Cyst, …
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Etiology Motor Vehicle Accident Fall Sport injuries Vigorous Exercise Bone Diseases
Osteoporosis Osteomyelitis Cyst, …
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Etiology Motor Vehicle Accident Fall Sport injuries Vigorous Exercise Bone Diseases
Osteoporosis Osteomyelitis Cyst, …
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Etiology Motor Vehicle Accident Fall Sport injuries Vigorous Exercise Bone Diseases
Osteoporosis Osteomyelitis Cyst, …
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Etiology Motor Vehicle Accident Fall Sport injuries Vigorous Exercise Bone Diseases
Osteoporosis Osteomyelitis Cyst, …
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Types of Fracture
Ordinary Caused by a force Normal bone
Pathological Caused by trivial force Diseased (weak) bone
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Types of Fracture Ordinary
Caused by a force Normal bone
Pathological Caused by trivial force Diseased (weak) bone
Osteoporosis Osteomyelitis Tumour, cyst, ..
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Types of Fracture Incomplete
Fracture line is incomplete Only one cortex is broken
Complete Fracture line is complete Bothe cortices are broken
www.childrensmemorial.org/
www.childrensmemorial.org/
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Types of Fracture Incomplete
Green-stick One cortex is broken Other cortex is bent
In children
Lee P et al. Radiographics 2004;24:1009-1027
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Types of Fracture Complete
Simple: One fracture line Two bone fragments
Comminuted: More than one fracture line More than two bone fragments More soft tissue injuries
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Types of Fracture Complete
Simple: Hairline (Fissure)
In repeated stress e.g. march fracture in
metatarsals Transverse Oblique Spiral
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Types of Fracture Complete
Comminuted: Butterfly Segmental Multiple fragments Compression
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Types of Fracture Undisplaced
Normal alignment maintained
Displaced Deformed from
normal alignment
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Types of Fracture Closed
Skin intact
Compound (Open) Skin not intact Communicating to
outside
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Types of long bone fractures Metaphyseal Diapyseal Articular Epiphyseal
(children)
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Sign and Symptoms of Fracture Pain Swelling Deformity Local tenderness Loss of function
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Diagnostic Evaluation
X-ray The most useful
MRI, CT-scan In suspected cases In intra-articular fractures
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Fracture Healing Stages of fracture healing:
Hematoma Inflammation Repair Remodeling
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1. Hematoma Bleeding caused by vessel rupture
Hematoma collects Bone at fracture edges dies
Rockwood and Green
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2. Inflammation Inflammatory cells accumulate Inflammatory mediators (cytokines) New blood vessels proliferate
Rockwood and Green
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2. Inflammation Mesenchymal cells accumulate
After 1 week forms granulation tissue Osteoclasts remove necrotic bone at
fragment ends growth factors stimulate the proliferation and
differentiation of mesenchymal stem cells Formation of connective tissue
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3. Repair Connective tissue differentiates Cartilage and fibrous tissue form
Soft callus formation (2-3 weeks) Movement at fracture stimulates more callus
Rockwood and Green
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3. Repair - Tissue Differentiation
connective tissue
granulation tissue
Giemsa stain
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3. Repair Vascular and cellular response leads to tissue
differentiation and mineralization resulting in restoration of mechanical integrity
Fibrocartilage mineralizes (converts callus to woven bone)
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Tissue Differentiation Cascade
Cartilage formation BoneMineral deposition
Masson-Goldner
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Callus Formation Periosteal callus
forms along the periphery of the fracture site Intramedullary callus
forms in the center of the fracture site Endochondral ossification at the site of the
fracture hematoma
Chemical and mechanical factors stimulate callus formation and mineralization
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Callus Formation Stability adequate in axial plane Angulation can still occur
fracture ends linked together by soft callus hard callus stage starts & lasts until fragment
ends are firmly united by new bone (3-4 m)
www.landesbioscience.comRockwood and Green
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4. Remodeling Woven bone slowly replaced by lamellar
bone (few months to years) Medullary cavity is reconstituted Bone is restructured in response to stress and
strain
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Fracture healing - summary1. Inflammation
Hematoma Mesenchymal cells
2. Soft callus Granualation tissue Fibro-cartilage
3. Hard callus Intramembranous bone
formation Enchondral ossification
4. Remodeling bony bridging
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Fracture healing - summary Summary
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Prerequisites for Bone Healing Adequate blood supply Adequate mechanical stability
If either is lost: results in delay in bone healing or no healing
occurs Smoking causes delay in bone union or
nonunion
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Complications of fractures Early:
Shock Compartment syndrome Fat embolism Deep vein thrombosis, embolism Infection
Delayed Malunion Delayed union / Nonunion
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Complications of fractures Shock
loss of blood Fractured femur could bleed 2L easily Fractured Pelvis could bleed 4L easily Open fractures with vascular injuries
What is the normal blood volume? How much bleeding could be tolerated?
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Complications of fractures Compartment syndrome
The compression of nerves, blood vessels, and muscle inside a closed body space (compartment)
Causes tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure within the compartment
More common in Forearm and leg (why?)
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Complications of fractures Deep Vein Thrombosis, Embolism
Caused by Increased pressure in compartment Interrupted venous return Hematoma
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Complications of fractures Infection:
More in open fractures Depends on amount of contamination and tissue
necrosis Possible in closed fractures
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Complications of fractures Delayed
Malunion: deformity Delayed union Non-union
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Management of fractures
First aid: ABC Other injuries Cover wounds Bone immobilization Definitive treatment of fracture
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Management of fractures Assessment
Type, location and severity of fracture Soft tissue damage Age and health status of patient Affection of other parts or organs
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Management of fractures Goals:
To regain and maintain correct position and alignment.
To regain the function of involved part. To return the patient to usual activities in the
shortest time and at the least expenses.
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Definitive treatment of fractures Conservative
Simple fractures More in children
Operative More complex fractures Articular fractures More in adults
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Conservative - closed reduction Is the most common non surgical method
for managing a simple fracture. Splints:
as upper extremity bones do not bear weight, splints may be sufficient to keep bone fragments in place.
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Conservative - closed reduction Casts :
A cast is an immobilizing device made up of layers of plaster or fiber glass.
Allows early mobility and reduces pain
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Conservative - closed reduction Traction:
Application of a pulling force to a part of the body
Uses a system of ropes, and weights to provide reduction, alignment and rest
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Open reduction / internal fixation Achieves perfect reduction Permits early mobilization
It is often preferred for elderly patients who are susceptible complications of immobility
Best for adults and in intra-articular fractures Uses pins, screws, rods, plates, .. After bone union, the metal may be removed,
depending on the location and type of fracture
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Examples of internal fixation Screws Wires Nails
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Open reduction, internal fixation Forearm fractures in adults (Plates)
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Nail in Tibial Fractures Intramedullary Nail
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Plate for comminuted Femur fracture
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Intra-articular fracture
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External fixation Ideal for open fractures where wound care
is needed and operation is hazardous Often used temporarily until wounds recover
Image fromC. Turen MD
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External fixationNail later
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Summary What is a fracture Types of fractures Fracture healing and requirements Management