Healing Process And Complications Of Bone Fractures

Healing Process And Complications Of Bone Fractures

Question: Describe the healing of the fracture wound and complications in the healing of the fracture.

Answer.Healing of a fracture wound

“Importance of proper care during bone fracture recovery”

bone fracture healing process

1. Immediate effect of a fracture

• After fracture haversian vessels of bone are torn at the fracture site so the vessels periosteum and marrow cavity cross the fracture line.
• There is considerable extravasation of blood in fractured area but at the same time, there is lack of circulation and loss of blood supply.
• Due to disruption of blood supply and tearing of blood vessels, there is death of bone marrow adjacent to fracture line.
• Blood clot that forms plays an important role in healing of fracture through replacement by granulation tissue and its subsequent replacement of bone.

bone fracture healing

“Understanding the stages of bone fracture healing”

2. Callus formation

• It is the structure which unites the fracture end of bone and consists of firous tissue, cartilage and bone.
• There are two types of callus:
  1. External callus: It consists of new tissue which forms around the outside of two fragments of bone.
  2. Internal callus: It consists of new tissue arising from the marrow cavity.

“Role of callus formation in bone healing”

• Periosteum is an important structure in callus formation and ultimate healing of the fracture.
• Cells of the periosteum torn at the fracture line usually die but peripheral to the area there is a flurry cellular activity within hours of injury.
• The fibrous layer of periosteum is inert and lifted away from the surface of bone by proliferation of cell in osteogenic layer of periosteum which assumes features of osteoblasts which, in turn, begins the formation of small amount of new bone at some distance from the fracture site.

stages of bone healing

“Medications linked to impaired bone healing”

• There is continuous proliferation of osteogenic cells forming collar of callus over the surface of fracture.
• New bone which begins to form an external callus consists of irregular trabeculae.
• This differentiation of cells into osteoblast and subsequent formation of bone occurs in deepest part of callus collar.
• In rapidly growing area of collar, osteogenic layer differentiates into chondroblasts rather than osteoblast and forms cartilage.
• The cartilage fuses with bone and begins to calcify by endochondral bone formation. The calcified cartilage is gradually resorbed and replaced by the bone.
• Shortly after the fracture endosteum proliferates within the week to form new bone which unites and establishes the continuity of bone.
• After this bone external and internal callus remodel to form indistinguishable bone.

complications of bone fractures

“Treatment options for delayed bone healing”

Complications

• Delayed union and non­union of the fragments of bones are complications of the healing process. They result when the calluses of osteogenic tissue over each of the two fragments fail to meet and fuse.
• Local infection and presence of foreign bodies
• Fibrous union in a fracture usually arises as a result of a lack of immobilization of the damaged bone.
• Lack of calcification of newly formed bone in the callus may occur.