June 22, 2014 1

Stages in the Healing

Stages in the Healing
of a Bone Fracture
of a Bone Fracture
June 22, 2014 2

There are many theories concerning fracture healing,

There are many theories concerning fracture healing,
but as a general rule then 3 phases :
but as a general rule then 3 phases :
-
-
Inflammatory
Inflammatory
-
-
Reparation
Reparation
-
-
Remodeling
Remodeling
June 22, 2014 3

The
The
AO teaching
AO teaching
concerning fracture healing diided
concerning fracture healing diided
into :
into :
1. Inflammatory
1. Inflammatory
2. Soft Callus
2. Soft Callus
3. Hard Callus
3. Hard Callus
. Remodelling
. Remodelling
June 22, 2014 4

!ematoma formation
!ematoma formation

Torn blood essels

Torn blood essels
hemorrhage
hemorrhage

A mass of clotted blood

A mass of clotted blood
"hematoma# forms at
"hematoma# forms at
the fracture site
the fracture site

$ite becomes s%ollen,

$ite becomes s%ollen,
painful, and inflamed
painful, and inflamed
&igure '(14(1
1
Hematoma
Hematoma formation
June 22, 2014 5

&ibrocartilaginous
&ibrocartilaginous
callus forms
callus forms

)ranulation tissue
)ranulation tissue
"soft callus# forms
"soft callus# forms
a fe% days after
a fe% days after
the fracture
the fracture

*apillaries gro%
*apillaries gro%
into the tissue and
into the tissue and
phagocytic cells
phagocytic cells
begin cleaning
begin cleaning
debris
debris
&igure '(14(2
2 Fibrocartilaginous
callus formation
External
callus
New
blood
vessels
Spongy
bone
trabeculae
Internal
callus
(fibrous
tissue and
cartilage
June 22, 2014 6

+ony callus formation

+ony callus formation

,e% bone trabeculae

,e% bone trabeculae
appear in the
appear in the
fibrocartilaginous callus
fibrocartilaginous callus

&ibrocartilaginous callus
&ibrocartilaginous callus
conerts into a bony "hard#
conerts into a bony "hard#
callus
callus

+one callus begins 3-4

+one callus begins 3-4
%ee.s after in/ury, and
%ee.s after in/ury, and
continues until firm union
continues until firm union
is formed 2-3 months later
is formed 2-3 months later
&igure '(14(3
!
"ony callus
formation
"ony
callus of
spongy
bone
June 22, 2014 7

+one remodeling
+one remodeling

01cess material on
01cess material on
the bone shaft e1terior
the bone shaft e1terior
and in the medullary
and in the medullary
canal is remoed
canal is remoed

*ompact bone is laid

*ompact bone is laid
do%n to reconstruct
do%n to reconstruct
shaft %alls
shaft %alls
&igure '(14(4
# "one remodeling
Healing
fracture
June 22, 2014 2
Clinical
union
Radiological
union
1
2
! #
June 22, 2014 9
References
References
1( 1(
3e.sopro/o $(: &racture healing, 4umpulan
3e.sopro/o $(: &racture healing, 4umpulan
ma.alah 5rof(dr(!($oelarto
ma.alah 5rof(dr(!($oelarto
3e.sopro/o,$p(+(,$p(+O, 2002, p126-31(
3e.sopro/o,$p(+(,$p(+O, 2002, p126-31(
2( 2(
4alfas: 5rinciples of +one !ealing, in
4alfas: 5rinciples of +one !ealing, in
%%%7medscape(com, last update 2001, access on
%%%7medscape(com, last update 2001, access on
8ecember 19, 200:(
8ecember 19, 200:(
3( 3(
3e.sopro/o $(: 5roses 5enyembuhan
3e.sopro/o $(: 5roses 5enyembuhan
tulang,tendon;saraf, pada 4umpulan ma.alah
tulang,tendon;saraf, pada 4umpulan ma.alah
5rof(dr(!($oelarto 3e.sopro/o,$p(+(,$p(+O, 2002,
5rof(dr(!($oelarto 3e.sopro/o,$p(+(,$p(+O, 2002,
p2::-9(
p2::-9(
June 22, 2014 10