Fracture Healing PDF

‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬ ‫اﻟﻠﮭم إﻧﻰ ظﻠﻣت ﻧﻔﺳﻰ ظﻠﻣﺎ ﻛﺛﯾرا‬ ‫وﻻ ﯾﻐﻔر اﻟذﻧوب إﻻ أﻧت‬ ‫ﻓﺎﻏﻔر ﻟﻰ ﻣﻐﻔرة ﻣن ﻋﻧدك‬ ‫وارﺣﻣﻧﻰ إﻧك أﻧت اﻟﻐﻔور اﻟرﺣﯾم‬  Fracture healing By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumatology  Inflammati...

‫ﺑﺳم ﷲ اﻟرﺣﻣن اﻟرﺣﯾم‬ ‫اﻟﻠﮭم إﻧﻰ ظﻠﻣت ﻧﻔﺳﻰ ظﻠﻣﺎ ﻛﺛﯾرا‬ ‫وﻻ ﯾﻐﻔر اﻟذﻧوب إﻻ أﻧت‬ ‫ﻓﺎﻏﻔر ﻟﻰ ﻣﻐﻔرة ﻣن ﻋﻧدك‬ ‫وارﺣﻣﻧﻰ إﻧك أﻧت اﻟﻐﻔور اﻟرﺣﯾم‬  Fracture healing By Prof. Dr. Mohamed Abdelhamid Professor of Orthopedics and Traumatology  Inflammation: Inflammation is a local vascular and cellular reaction of living tissue against an injurious agent (irritant). * Components of inflammatory process are: - white blood cells (leukocytes) and plasma proteins. - Inflammation is induced by chemical mediators produced by damaged host cells at site of inflammation. * Types of inflammation 1- Acute inflammation 2-Chronic inflammation  *Causes of Inflammation 1. Infections (Living agents):bacteria ,viruses, fungi and parasites. 2. Non – Living agents: A- Trauma B- physical agents, such as cold and heat (e.g., burns or frostbite), irradiation, electricity. C- Chemical agents, such as acids and alkalies. D- Foreign bodies e.g. sutures. E- Hypersensitivity reactions against environmental substances or against self – antigens. F- Necrotic tissues.  *Acute inflammation has two major reaction: I- Local Vascular reaction : 1. Transient vasoconstriction (only for seconds 2. Vasodilation of arterioles and capillaries 3. Increased vascular (capillary) permeability 4. Slowing of the blood stream (stasis) * Inflammatory fluid exudate  * Mechanism of formation: 1. Arteriolar vasodilation and increased volume of blood flow. 2. Increased vascular permeability that allows the movement of protein-rich fluid and cells (exudate) from capillaries into the interstitial tissues. 3. increases the osmotic pressure of the interstitial fluid leads to further exudation of inflammatory fluid exudate. II- Local Cellular Reaction (Leukocytic Emigration) * The sequence of events 1 ) Margination of leukocytes 2 ) Firm adhesion of leukocytes to the vascular endothelium 3 )- leukocytic emigration through the inter-endothelial cell gaps 4 ) Chemotaxis 5 ) Phagocytosis  The story in bone healing 1- Hematoma: forms and provides a source of hematopoietic cells capable of secreting growth factors. 2- Inflammation: Macrophages, neutrophils, and platelets release several cytokines they may be detected as early as 24 hours post-injury 3- Demolation: Inflammatory cells invade the haematoma and initiate lysosomal degradation of necrotic tissue. 4- Granulation tissue formation: BMPs, fibroblasts and mesenchymal cells migrate to fracture site and granulation tissue forms around fracture ends. 5- within 4–5 days Pluripotential mesenchymal stem cells invade the area and differentiate into fibroblasts, chondroblasts, and osteoblasts. Osteoblasts and fibroblasts proliferate. runx-2/osterix, which are critical for differentiation of osteoblastic cells. 6- Callus formation: (4-6 weeks) a) Soft callus b) Hard callus 7- Remodeling: final stage (months or years according to age)  Factors affecting Bone healing A) Mechanical: 1- Stability: unstable fracture interrupt granulation tissue. 2- Gap: between fracture ends and soft tissue itrapment. 3- compression: resolves both problems B) Biological factors. 1- Nutritional deficits, smoking, and diabetic patient. 2- Parathyroid hormones stimulate the differentiation and proliferation of osteoblasts 3- Aging; decrease the quantity of the muscle stem cells and negatively affect the healing process. 4- Infection of the fracture site at healing process. 5- Bl. supply: Open, comminuted fracture, and the extent of soft tissue injury Complications of fracture healing 1. Infection: this is the most common complication of fractures. 2. Non-union: no progression of healing within six months. Two types: Trophic; Hypertrophic 3. Mal-union: healing occurs but with deformity. 4, Delayed union: is characterised by 'persistence of the fracture line and a scarcity or absence of callus formation' on x-ray. Healing is still occurring but at a much slower rate than normal. Duties of physician Understand the fracture Achieve conditions of healing Consider factors affecting healing Avoid complications Duties of physiotherapist Understand the fracture Consider factors affecting Fracture healing Avoid complications Restoration of the function: a) Of the part fractured b) Of the Limb of the part fractured c) Of the surrounding joints and muscles d) Of the patient himself