Bone fracture natural history, complications and prognosis: Difference between revisions
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==Natural History== | |||
===Bone Healing=== | |||
{{main|Bone healing}} | |||
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The [[clotting|blood coagulates]] to form a blood [[clot]] situated between the broken fragments. Within a few days [[angiogenesis|blood vessels grow]] into the jelly-like matrix of the blood clot. The new blood vessels bring [[white blood cell]]s to the area, which gradually remove the non-viable material. The blood vessels also bring [[fibroblast]]s in the walls of the vessels and these multiply and produce [[collagen]] fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied. | |||
At this stage, some of the fibroblasts begin to lay down [[bone matrix]] ([[calcium hydroxyapatite]]) in the form of insoluble [[crystal]]s. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone ''is'' a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone [[Fibrocartilage callus|callus]] is on average sufficiently mineralized to show up on [[X-ray]] within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury. | |||
Several factors can help or hinder the [[bone healing]] process. For example, any form of [[nicotine]] hinders the process of bone healing, and adequate nutrition (including [[calcium]] intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength. | |||
<gallery> | |||
Image:K-Knie-z2.jpg|X-ray showing a healed [[tibia]] fracture with pins. | |||
Image:K-Fuss-z2.jpg|X-ray showing fractured tibia and pinning. | |||
</gallery> | |||
==References== | ==References== | ||
Revision as of 15:14, 6 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Natural History
Bone Healing
The natural process of healing a fracture starts when the injured bone and surrounding tissues bleed. The blood coagulates to form a blood clot situated between the broken fragments. Within a few days blood vessels grow into the jelly-like matrix of the blood clot. The new blood vessels bring white blood cells to the area, which gradually remove the non-viable material. The blood vessels also bring fibroblasts in the walls of the vessels and these multiply and produce collagen fibres. In this way the blood clot is replaced by a matrix of collagen. Collagen's rubbery consistency allows bone fragments to move only a small amount unless severe or persistent force is applied.
At this stage, some of the fibroblasts begin to lay down bone matrix (calcium hydroxyapatite) in the form of insoluble crystals. This mineralization of the collagen matrix stiffens it and transforms it into bone. In fact, bone is a mineralized collagen matrix; if the mineral is dissolved out of bone, it becomes rubbery. Healing bone callus is on average sufficiently mineralized to show up on X-ray within 6 weeks in adults and less in children. This initial "woven" bone does not have the strong mechanical properties of mature bone. By a process of remodeling, the woven bone is replaced by mature "lamellar" bone. The whole process can take up to 18 months, but in adults the strength of the healing bone is usually 80% of normal by 3 months after the injury.
Several factors can help or hinder the bone healing process. For example, any form of nicotine hinders the process of bone healing, and adequate nutrition (including calcium intake) will help the bone healing process. Weight-bearing stress on bone, after the bone has healed sufficiently to bear the weight, also builds bone strength.
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X-ray showing a healed tibia fracture with pins. -
X-ray showing fractured tibia and pinning.
