FRACTURE HEALING

Like healing of soft tissue wounds, healing of fracture is very similar, except the end result is mineralised mesenchymal tissue ( bone).
Healing of a fracure begins as soon as it is broken through a continous stages of healing.

                          Stages of fracure healing of cortical bone (FROST, 1989)

1. Stage of haematoma
2. Stage of granulation tissue
3. Stage of callus
4. Stage of remodelling
5. Stage of modelling



Stage of haematoma:

  • last upto 7 days
  • fracture end necrosis occurs
  • sensitisation of precurser cells
Stage of granulation tissue:

  • upto 2-3 weeks
  • proliferation and differentiation of daughter cells into vessels, fibroblasts, osteoblasts etc
  • fracture still mobile 
 Stage of callus:

  • last upto 4-12 weeks
  • mineralisation of granulation tissue
  • radiologically visible calus
Stage of remodelling:

  • lasts upto 2 years
  • lamellar bone formation 
  • remodelling of callus
  • callus becomes sharply defined and densed
Stage of modelling

  • lasts many years
  • endosteal and periosteal modelling
                                                    Healing of cancellous bone:


  • Union can occur directly between bony surfaces
  • no stage of callus formation




Factors affecting healing

  1. Age: In children fracture heals fast
  2. Sex : no difference in healing
  3. Type of bone: Flat and cancellous bones unite faster
  4. Pattern of fracture: spiral fractures unites faster than oblique fracture
  5. Type of reduction: good apposition results in faster union
  6. Compression of fracture site: compression enhances rate of union

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