the fracture is not tender to palpate or with movement. Hard callus is weaker than normal bone but is better able to withstand external forces and equates to the stage of "clinical union", i.e. Soft callus is plastic and can easily deform or bend if the fracture is not adequately supported. Soft callus is organised and remodelled into hard callus over several weeks. These cells lay down woven bone which stabilises the fracture site. Over the next few weeks, this primary callus is transformed into a bony callus by the activation of osteoprogenitor cells. Phase 2 - Reparative Phase (Days - Weeks)
This is not readily visible on radiography. Phase 1 takes approximately a week, forming a primary callus which is non-mineralized. This forms a matrix for bone formation and primary callus. The fibroblasts, chondroblasts and the ingrowth of capillaries is then infiltrated by fibrovascular tissue. The inflammatory reaction results in the release of cytokines, growth factors and prostaglandins, all of which are important in healing. This prevents additional bleeding and provides structural and biochemical support for the influx of inflammatory cells. Immediately at the time of fracture, the space between the ends of the fracture is filled with blood, forming a haematoma. Phase 1 - Inflammatory Phase (Hours - Days) The pathophysiological sequence of events that occur following a fracture for bone healing can be divided into three main phases
BONE FRACTURE CRACK
Stress: Small crack or severe bruising within a bone.Spiral: Fracture spirals around the bone, or a helical fracture path usually in the diaphysis of long bones, common in twisting injuries.Oblique: Fracture is orientated obliquely across the bone.Transverse: Fracture is in a straight line across or perpendicular to axis of the bone.
BONE FRACTURE SKIN
Open / Compound: Skin has been pierced or punctured by the bone or by a blow that breaks the skin at the time of the fracture.Closed / Simple: Bone has not pierced the skin.
Displaced / Unstable: Fractured portions of bone are separated or misaligned.Non-Displaced / Stable: Fractured ends of the bone line up.Incomplete: does not cross the bone completely (usually encountered in children).Complete: Extends all the way across the bone (most common).In general, there are many different classification systems used for fractures which fall within a set number of patterns: Together, insufficiency and fatigue fractures are often grouped together as stress fractures. running), resulting in microfractures and eventually, macroscopic failure (fatigue fractures). Chronic application of abnormal stresses (e.g.osteoporosis) or less frequently, genetic abnormalities (e.g. Weakened bone due to metabolic abnormalities (e.g.metastasis, or bone cyst), known as pathological fractures. Weakened bone from a focal lesion (e.g.A normal bone subjected to acute overwhelming force, usually in the setting of trauma.Fractures can occur in a variety of methods: 4.3 Phase 3 - Remodelling Phase (Months to Years)Ī fracture is a discontinuity in a bone (or cartilage) resulting from mechanical forces that exceed the bone's ability to withstand them.4.2 Phase 2 - Reparative Phase (Days - Weeks).4.1 Phase 1 - Inflammatory Phase (Hours - Days).
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