Fracture healing
Definition
A process of regeneration and repair ocurring across the fracture site passing through different phases of healing.
The 5 different stages of fracture healing are :
1) Stage of haematoma formation
2) Stage of granulation tissue
3) Stage of woven bone formation
4) Stage of lamellar bone formation
5) Stage of remodelling / consolidation
1) Stage of haematona formation
~ It is a simple stage of fracture healing as the bone fractured, bleeding occur immediately, the haematoma which is formed act as a vehical delivering the requried material for union and clearing the unwanted debris by chemotaxis.
If this stage is deficient as in open fracture healing, the fracture fails to unite.
2) Stage of granulation tissue
If this stage is deficient as in open fracture healing, the fracture fails to unite.
~ With in 8 hours of fracture there is inflammation which subsequently leads to subperiosteal and endosteal cellular proliferation.
This cells surround the broken end of the bone and try to produce cells which differentiate and organise to provide blood vessels, fibroblast, osteoblast etc. At the same time coagulated blood get absorbed and new cappillary start infiltrating this and cellular muscle.
3) Stage of woven(soft) bone formation
~ This proliferating cell which are osteogenic and chrondiogenic they start to get incooperating into fibrogenic, under the influence of bone morphogenic protien from a transforming growth factor beta and fibroblast growth factor. Therefore forming the primary woven (soft) bone.
This bone is soft as it is not fully mineralizef it occurs at 2nd & 3rd week of fracture.
4) Stage of lamellar(hard) bone formation
~ In this stage mineralization occurs and the primary woven (soft) bone is tranformed into lamellar (hard) bone. Lamellar bone is hard abd seen as a bridge or curve at the fractured site.
This indicate an early stage of union which occurs during 3rd & 4th week of fracture.
5) Stage of remodelling
~ Dont considered that the remodelling take place directly after the fracture unite.
Its takes months to year after unite.
Remodelling is repeat in children and the growing bone. Also slow in adult bone and almost nill in osteoporetic bone.
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