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This is the bone self-healing process/ repair/union that has the following processes

Inflammatory Phase.

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

Reparative Phase.

Fibrin strands form within the fracture hematoma

Revascularization begins
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

Remodeling Phase.

✓ 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

Factors affecting bone healing

Enhancing

Early Immobilization of fracture fragments
Bone fragments contact
Adequate blood supply
Proper Nutrition
Exercise- wt. bearing for long bones
Adequate hormones –Growth hormone, Thyroxin, Calcitonin
The electric potential across the fracture

Inhibiting

Extensive local trauma
Bone loss due to the severity of the fracture
Inadequate immobilization
Infection
Avascular Necrosis
Local malignancy
Dernervation
Age

References

Orthopedics at a glance