Fracture Healing by Dr. Nimer Khraim (DVMS, BVMS, MVSc)

Fracture Healing Union: the healing is complete in normal time Union: the healing is complete in normal time Delay union: fracture healing is not complete in normal time Delay union: fracture healing is not complete in normal time Non-union: fracture have failed to unite and signs to repair have ceased Non-union: fracture have failed to unite and signs to repair have ceased

Fracture Healing Radiographic signs of the union Obliteration of the fracture line Obliteration of the fracture line Bridging of the fracture area with the new bone Bridging of the fracture area with the new bone Remolding of the callus with the restoration of the continuity of the cortex and medullary cavity Remolding of the callus with the restoration of the continuity of the cortex and medullary cavity

Fracture Healing Radiographic signs of the delay union Fracture line is present Widen Fracture line is present Widen appear as active with the ragged or irregular edge appear as active with the ragged or irregular edge

Fracture Healing Not bridging the callus Not bridging the callus Marrow cavity is still open Marrow cavity is still open Adjacent bone show no significant sclerosis Adjacent bone show no significant sclerosis

Fracture Healing Radiographic signs of nonunion Visible fracture Visible fracture Poor callus formation and does not bridge the fracture line efficiently Poor callus formation and does not bridge the fracture line efficiently

Fracture Healing Round of fracture end which become sclerosis and thickness cortex with the bone formation in the medullary cavity Round of fracture end which become sclerosis and thickness cortex with the bone formation in the medullary cavity Generalized decrease density in the bone of the affected limb distal to the fracture due atrophy of disuse Generalized decrease density in the bone of the affected limb distal to the fracture due atrophy of disuse

Fracture Healing Etiology of nonunion and delay union Ischemia Ischemia Neoplasm Neoplasm Inadequate production Inadequate production

Fracture Healing Interposition soft T. in between fracture end Interposition soft T. in between fracture end Distracted fracture Distracted fracture Bone loss Bone loss Inadequate immobilization or fixation Inadequate immobilization or fixation

Fracture Healing Stripping of periosteum Stripping of periosteum Osteoporosis Osteoporosis Lose of soft T. attached to the fragment Lose of soft T. attached to the fragment

Fracture Healing Prevention of delay union Good immobilization to prevent further T. damage Good immobilization to prevent further T. damage Good apposition Good apposition Prevent infection Prevent infection Return the circulation to normal as possible Return the circulation to normal as possible

Fracture Healing Prevention of nonunion Not interposition of T. which prevent bridging of the callus Not interposition of T. which prevent bridging of the callus Avoid use of diathermy or x-ray therapy during the first week of healing Avoid use of diathermy or x-ray therapy during the first week of healing

Fracture Healing Stage of fracture healing Primary bone healing Rigid internal fixation may result in bony union through direct growth of havarsian system a cross the fracture Rigid internal fixation may result in bony union through direct growth of havarsian system a cross the fracture

Fracture Healing Secondary bone healing A- Stage of fracture impact Energy absorbed from the bone until a failure occur Energy absorbed from the bone until a failure occur When fracture occur this energy released into surrounding t. When fracture occur this energy released into surrounding t.

Fracture Healing B- stage of induction This stage occur in between fracture impact and the end of the of inflammation so is less differential This stage occur in between fracture impact and the end of the of inflammation so is less differential

Fracture Healing Following impact cells in fracture area are reduce to form bone. Following impact cells in fracture area are reduce to form bone. The stimulation involve enzymes, PH, O2 tension and bony morphogenic stimulant sub. The stimulation involve enzymes, PH, O2 tension and bony morphogenic stimulant sub.

Fracture Healing Stage of inflammation Begin immediately after fracture occur and persist until the initiation of cartilage or bone formation Begin immediately after fracture occur and persist until the initiation of cartilage or bone formation

Fracture Healing Fibrin of hematoma may stimulate cells regeneration and aid in immobilization of the fracture end Fibrin of hematoma may stimulate cells regeneration and aid in immobilization of the fracture end Granulation T. advanced into the hematoma and perform the same function as soft T. repair Granulation T. advanced into the hematoma and perform the same function as soft T. repair

Fracture Healing Stage of soft callus formation Fibroblast proliferation and ostiogenic cell of the periosteam and endosteum migrate and proliferate at the side of fracture to formation the external and internal callus Fibroblast proliferation and ostiogenic cell of the periosteam and endosteum migrate and proliferate at the side of fracture to formation the external and internal callus

Fracture Healing External callus play more important role in immobilization of the facture end External callus play more important role in immobilization of the facture end

Fracture Healing Hard callus formation callus gradually converted into woven bone in area of fracture callus gradually converted into woven bone in area of fracture

Fracture Healing The conversion occur through the endochondral ossification as endochondral ossification and mineralization of new osteoid progress the healing become visible radiographically The conversion occur through the endochondral ossification as endochondral ossification and mineralization of new osteoid progress the healing become visible radiographically

Fracture Healing Stage of remodeling Show change in shape of bone to allow function and restore normal strength Show change in shape of bone to allow function and restore normal strength The capability for remodeling is grater in immature animal than in old animal The capability for remodeling is grater in immature animal than in old animal

Factor Affecting on Fracture Healing

Age of animal In young animal clinical union occur due to 4 weeks while in the old animal the clinical union occur due to 8 week In young animal clinical union occur due to 4 weeks while in the old animal the clinical union occur due to 8 week

Factor Affecting on Fracture Healing Species Horse tend to heal poorly Horse tend to heal poorly Dog and cat heal readily Dog and cat heal readily Bird heal very rapidly Bird heal very rapidly

Factor Affecting on Fracture Healing Blood supply Related to location of fracture and the extend of injury Related to location of fracture and the extend of injury Site of injury Cancellous bone heal readily Cancellous bone heal readily

Factor Affecting on Fracture Healing Immobilization To eliminate shortening, angleation, and torsion force To eliminate shortening, angleation, and torsion forceReduction To reduce the amount of callus required to bridge the gap To reduce the amount of callus required to bridge the gap

Factor Affecting on Fracture Healing Infection Alter the circulation reaction and mineralization of callus by lowering the PH Alter the circulation reaction and mineralization of callus by lowering the PH

Complication of Fracture

Pressure source: animal remain in recumbent position or uneven pressure of plaster Pressure source: animal remain in recumbent position or uneven pressure of plaster A vascular necrosis of the bone A vascular necrosis of the bone

Complication of Fracture Shortening of the bone Shortening of the bone Nerve injury Nerve injury Osteomylitise Osteomylitise Shock and delay union Shock and delay union