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This is the bone self-healing process/ repair/union that has the following processes
Stage of hematoma formation- after the fracture, bleeding & edema precede a hematoma surrounding the fragment
There is swelling, edema & pain
The fracture fragments become devascularized
Injured bone is invaded by microphages which debride the area
Fibrin strands form within the fracture hematoma
Fibroblasts & osteoblasts produce collagen matrix at the fracture site.
Cartilage and fibrous connective tissue develop.
A) Formation of fibrocartilaginous callus.
✓ The phagocytic cells absorb the products of local necrosis.
✓ The hematoma changes to into Granulation tissue constituting of young blood vessels, fibroblasts, osteoblasts (the bone osteoid)
B) Formation bony callus (woven bone become calcified).
✓ Osteoid mineralization to form a network of cartilage, osteoblasts, and minerals
✓ Begins to appear by the 1st week of # and can be confirmed by X-ray
Ossification:- calcification of callous into the bone mass that prevents movement at the fracture site
✓ Begins 2-3 wks after fracture until the fracture is healed
✓ However, the fracture is still evident in the x-ray
✓ Pt can be converted from skeletal traction to cast or cast can be removed & the pt mobilized
Consolidation:- distance between bone continues to diminish & eventually closes & x-ray can confirm fracture union
✓ Excess material inside bone shaft is replaced by more compact bone
✓Excess cells are absorbed & union is completed.
✓Return of bone to its pre-injury structure, shape and strength
✓Bone remodeling enhanced by exercises & later weight bearing exercises
✓New bone is deposited at the site of the fracture
Early Immobilization of fracture fragments
Bone fragments contact
Adequate blood supply
Exercise- wt. bearing for long bones
Adequate hormones –Growth hormone, Thyroxin, Calcitonin
The electric potential across the fracture
Extensive local trauma
Bone loss due to the severity of the fracture