Fracture Healing, Cheat Sheet of Physiotherapy

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Fracture Healing

Introduction Pathology & Stages Local Factors influencing Osteogenesis Differences in healing of fractured bone treated by conservative & operative methods

Bone is unique in its ability to repair itself.,it can completely reconstitute itself by reactivating processes. Bone repair is a highly regulated process that can be seperated into overlapping histologic,bio-chemical & bio-mechanical stages. The completion of each stage initiates the next stage and this is accomplished by a series of interactions and communications among various cells and proteins located in healing zone.

The events in the process of fracture healing can be divided into 3 phases. 1.Inflammation Phase 2.Reparative Phase 3.Remodelling Phase

Pathology & Staging

An injury that fractures bones damages not only the cells,blood vessels and bone matrix,but also the surrounding soft tissue including the periosteum and blood vessels. Immediately after fracture,rupture of blood vessels results in hematoma which fills the fracture gap and also the surrounding area. The clotted blood provides a fibrin mesh which helps seal off fracture site and allows the influx of inflammatory cells and ingrowth of fibroblasts & new capillary vessels.

Inflammation Phase

Initial events following fracture

of a long bone diaphysis

The inflammatory cells releases the cytokines that stimulate angiogenesis. As the inflammatory response subsides,necrotic tissue and exudate are reabsorbed and fibroblasts and chondrocytes appear and start producing a new matrix,the fracture callus. Electronegativity found in the region of fresh fracture may also simulate the osteogenesis.

Reparative Phase

Early repair of a diaphyseal

fracture of a long bone

As the callus matures and transmits weight-bearing forces,the portions that are not physically stressed are reabsorbed,and in this manner the callus is reduced in size until the shape and outline of fractured bone has been reestablished. The medullary cavity is also restored.

Remodelling Phase

Progressive fracture healing by

fracture callus

1. Injury variables
2. Patient variables
3. Tissue variables
4. Treatment variables

Factors influencing

osteogenesis

I).OPEN FRACTURES:- Severe open fractures cause soft tissue disruption, fracture displacement, and, in some instances, significant bone loss. Extensive tearing or crushing of the soft tissue disrupts the blood supply to the fracture site, leaving necrotic bone and soft tissue, impeding or preventing formation of a fracture hematoma, and delaying formation of repair tissue

1.Injury varibles

Displacement of the fracture fragments and severe trauma to the soft tissues retard fracture healing, probably because the extensive tissue damage increases the volume of necrotic tissue , impedes the migration of mesenchymal cells and vascular invasion, decreases the number of viable mesenchymal cells, and disrupts the local blood supply.

Open fracture