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Healing of Fractures

 

 

Fracture healing is both fascinating and complex.  It basicly involves a series of processes designed to remove dead-injured tissue and bone from the fractured site. This is then followed the movement of cartilage and bone forming cells to form the structure necessary for repair.

The steps include:

Inflammation – the stage of removal of damaged tissue and bone.

Repair – The process of building the new bone and tissue scaffold

Remodelling – The stage where the newly healed fracture undergoes further modification based on the areas stressed with movement and load. The bone is thickened at points that undergo most pressure during function.

The fracture has to be well aligned in a 3 dimensional plane to enable healing to occur in good position. This can be done using a splint, cast or surgery. As the fracture heals, the amount of support needed reduces and the part can be loaded by bodyweight or its use increased.

Fractures in the upper limb generally require 6 weeks to unite satisfactorily. Lower limb fractures on the other hand require 12 weeks. In children these durations are halved. These figures are only estimates and depend on the serial follow up progress radiographs and examination findings that often change the duration of splintage and care.

Fractures which involve the joint require perfect reduction of fragments as incongruency of the joint will lead to arthritis and pain, especially in the those joints which bear weight – lower limbs. This need in care favours surgical options for these fractures especially when the fragments are displaced.

Fractures that are not involving the joint require techniques that will adequately hold position but allow the patient to be relatively mobile. This is often the reason why surgical option is chosen for fractures of the thigh bone and hip to allow rapid ambulation and avoid the problems of prolonged bed rest.

The need for rapid return to activity and function brings about continued research in fracture treatment techniques and protocols.  Methods to speed up healing are also in frontline research.


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