Professional Documents
Culture Documents
Clinical features
Frequent signs and symptoms of bone fracture,
First aid :
Ensure that the airway is clear, to control any external hemorrhage, to cover any wound
with a clean dressing, to provide some form of immobilization for a fractured limb,
Clinical assessment
It must be emphasised again that an immediate assessment of the whole patient is required
to exclude injuries to other systems before examination of the skeletal injury. Examination
of the limb should determine:
1. whether there is a wound communicating with the fracture
2. whether there is evidence of a vascular injury
3. whether there is evidence of a nerve injury
4. whether there is evidence of visceral injury.
Resuscitation
Many patients with severe or multiple fractures, or fractures associated with other visceral
injuries, are shocked on arrival at hospital. Time must be spent on resuscitation and dealing
with any other life-threatening injuries before definitive treatment for the fracture is begun
, replenishment of the circulating blood volume, either with transfused blood when time
permits cross-matching, or alternatively by the use of plasma expanders and blood
substitutes.
REDUCTION
This first principle must be qualified by the words if necessary. In many fractures
reduction is unnecessary, either because there is no displacement or because the
displacement is immaterial to the final result, there are three types of reduction
METHODS OF REDUCTION
When reduction is decided upon it may be carried out in three ways:
1. by closed manipulation
2. by mechanical traction with or without manipulation
3. by open operation.
IMMOBILISATION
this second great principle of fracture treatment must be qualified by the words if
necessary. Whereas some fractures must be splinted rigidly, many do not require
immobilisation to ensure union,
Rehabilitation
Pathologic stages of fractured bone healing
1. Reactive phase
i. Fracture and inflammatory phase
ii. Granulation tissue formation
2. Reparative phase
iii. Cartilage callus formation
iv. Lamellar bone deposition
3. Remodeling phase
v. Remodeling to original bone contour
Reactive phase
After fracture, the first change seen by light and electron microscopy is the presence of blood
cells within the tissues adjacent to the injury site. Soon after fracture, the blood vessels constrict,
stopping any further bleeding. Within a few hours after fracture, the extravascular blood cells
form a blood clot, known as a hematoma. All of the cells within the blood clot degenerate and
die, Within this same area, the fibroblasts survive and replicate. They form a loose aggregate
of cells, interspersed with small blood vessels, known as granulation tissue
Reparative phase
Days after fracture, the cells of the periosteum replicate and transform. The periosteal cells proximal
(closest) to the fracture gap develop into chondroblasts which form hyaline cartilage
The next phase is the replacement of the hyaline cartilage and woven bone with lamellar bone. The
replacement process is known as endochondral ossification with respect to the hyaline cartilage
and bony substitution with respect to the woven bone. Substitution of the woven bone with lamellar
bone precedes the substitution of the hyaline cartilage with lamellar bone. The lamellar bone begins
forming soon after the collagen matrix of either tissue becomes mineralized.
Remodeling phase
The remodeling process substitutes the trabecular bone with compact bone. The trabecular bone is
first resorbed by osteoclasts , Then osteoblasts deposit compact bone within the resorption pit.
Eventually, the fracture callus is remodelled into a new shape which closely duplicates the bone's
original shape and strength. The remodeling phase takes 3 to 5 years depending on factors such as
age or general condition.[6] This process can be enhanced by certain synthetic injectable
biomaterials, such as cerament, which are osteoconductive and actively promote bone healing.