Bone Healing – An overview
Oct 18, 2011
Fractures heal by the following steps:
- Hemorrage in the area of the fracture.
- Clot formation.
- Inflammation and edema in the area.
- Proliferation of mesenchymical cells.
- Cartilage and bone formation.
- Remodeling of callus back to normal bone.
The result is replacement of the tissue in the fracture gap with progressively stiffer and stronger tissue.
Granulation tissue–connective tissue–fibrous tissue–cartilage – mineralized cartilage–lamellar bone–cortical bone. Each step the tissue gets progressively stiffer until bone is reformed.
Callous formation is divided into 3 locations:
- Medullary callous (inside the bone)
- Periosteal callous (around the bone)
- Intercortical briding callus (between fracture ends). The amount of callous at the fracture site is inversely related to the stability at the fractures.
Fracture healing depends on blood supply at the fracture site, reduction of fracture fragments and the degree of stabilization of the fracture fragment.
- 4The four A’s of radiographic evaluation of bone healing:
- Alignment – restoration of the bone as a whole.
- Apposition – realignment of fracture fragments.
- Apparatus – fixation device used to stabilize fracture.
- Activity – amount of callous formed and degree of bone resorption.
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