Medical knowledge | Traumatology » Imre Szerb - Bone healing, fracture management

Hematoma Formation (1 st) (lnflammator Phase ~~. ■ . -. Fracture hematoma ■ blood from broken vessels forms a clot. ■ 6-8 hours after injury ■ swelling and inflammation to dead bon e cells at f racture site Cellular Formation Phase(2 nd ) (Reparative Phase) ~.- .• -. - '. . ■ lnflux of endosteal cells from cambium layer FlbrocartHage Soft calllus--,,,jl New blood- -~~ vessets Ca 11 us Formation P::t11 a:seit @ird] (Reparative .Pt:ira~~J 1 . ,. ■ Fibroblasts de.p asit cof[[afgJein fi;r~ l l tiie granulation tissue -. ■ : Soft ca11 us: i·s : fö:rme:a,llE=Js;t·s1;·~ -~ :W§ ··. ·, e~ · "~K •A-:-~· 1-,lLJ' · ·:·· '•··>,.:· r ,:,=S-, ·; ·· :(1i·,:::~ "i:. ; ::. i . l ; I . . fi f n.Q"C .9 :,a , n1~de- , , ,-~: n ,'"e,, ~ C~f 9 . . . :, . . . -s~ ,-, . ·,. , .• :.?::,'-ö .-,=- , ,'-'ii i:~--~ ,- ••~'-h - ~; .~,

''' - ' quickly to create rigid immobilization) B-ony caHus - Spongry---+~ bone Gallus Phase continu,e,dt . . . . ·>•··· . =·- :•.· ,'-<.-,e,•,·' , .< ■ T he ha rd ca II us Iasts:3 ,4- ·Jrt::a~ n·fP:ts. . ·-. . . . . '. . ' '. ·-.· ~- ' . -. .- . . . '. ' . -';, ■ Hard . · callus ' . -· a ·g·radü: .• · af rtö:n' ., , -· ' tffetci1' . ' r·ő;, :f1 .~ ,,:,,li(, ·a~1i :-· J? . · , PJ -P-, ,) ·;-■ :9: oni.ei; Js::- be -·trlA:·i:-n:, -:,· i of s:fre:n,: fh]:::n,ranrct -·-- . ,e,: ,--:;;:-, . · ·, -, im·m:o'bJTfze··- - - - - 1 1 »"■ •. ,<-.· •-·-•-•X ~1-f t7Q;n·e ·r t1';'í""l1n:,r·a~~~·11!•1·1z.:~)a:it';·1 {o•n, ~IAu „ro· ;·e;,lfJLW-, !s, n· '·.l'O:i;t•· :;: ;~,o ·, c-'~c-- -1~

1rr:• · .~•, ; . - 1 rr:1:• ~:, :1tr ~- ~·- 111' ~'",!~ •-1-~~~{i~~ - ;- -~lrr • ~ / ~~- ~ -I . , ~ i111d:tBfmn;ifFYs-'f~acJ~ ;fi o·ti•a .fl, e ;: -.e~ &·•> ' .' , -:': " ,• ,' , •, ,' ~/ ,J ,' <W~J ~-:J:: •: W:TL -- ,;;;- i I ;: . ,, ::' :I ' , 1 1 l : ) . ) -1~ Spongy bone ,Q.steoblasts ,9 Bony caHus formation Ossification Phase (4th) cont. ■ Fracture is bridged and united ■ p hase:,-:·5: : ,,•t·.•;•CX't~,lr'!:: Remo de1ing -- ,/;. ■ Remodeling harci callu.§' Ja'i~Q'l:nJ]J:9JZfi t):om,e ■ May. take a few-years ■ comp1efe.d·Wh~nfhe f~a cfu:r~á b:a~te m ,as b,e.e:,n · reisto,re::d f:a:1ts= : :orrgJ n::a1~f,o•:rm~· OJl sim,a:g:e 1d'fR:e "lrf:fi' >i ea ör -. tl· .! ,,l ,! 't"'- tCari :V- }J, ,L.n· ·'·e ~-~"• : J .,

r'/'f ~1-.~1,st'ar1 , - ✓ (?. ,~ /4~ , ,;,;,r k , -,C- ,,," = ,-,,~ .,, -;, ~-----"k-•~;:;:,. , , silr ~;,e' -~-s~-.s-e ;§: rp a·c·erl1,lioJrl~Iíi ·.,-,;T ~ ~~ I ,: ~ .J ;, ;, i,. "--« :./ ;, ,-,-: 1 ;)' t J , A -~ . : ··; t - ~ - - -- . --., Types of Fractures: Spiral or oblique ■ Caused by violence transmitted lhrough limb. fro; m a. distance (twisting movements) Types of Fractures:C.omminuted fracture (Morphology) 91. L , , , -. ·• .- l ~ -. , -. íl ~ .,, . ■ More bone pieces - high energy trauma ■ The distal piece is de.scribed in relatign tg th·e p.roii:maJ piece .a a Type of Fractures: Poximal Fractures (Location) ■ Fracture can involve the joint: 1ntraarticular ■ results in malalignment of joint surfaces. Crush fractures ■ Fracture in cancellous bone: result of compression

(östeopótosis) Avulsion fracture ■ Caused by traction, bony fragment usually torn off by a tendon or ligament. ■ What muscle group attaches to this bony prominence and what nerve also runs in close proximity? ■ • Forearm·JI exors<(oom mon flexor origfn) : · .-· .: ■ : . ulbaYti'elve ·-,.- BT lnitial Treatment o.f Fi:r;a:af~uraes • - '•·: -·,, -~".; .·· ·r.~•: --.·;rl, ~c;,•. =-:-6>~~:-!T::--,;C ·;.• · · •.,~· . .b b ,(k ■ Red uct 10n, W1 ·1[t'{ Í '. CCi''M : üJa ,. ·n:J~Jr a.ccom pr1s h •- ed by, e:lt, closed (:~léterrta:l 1 . . . ,.,·•· ,,,,,· 1 L. -.-, . . , , , ,, · ti~ .(' .-·• ti - -. e· ·re•'·•a t~L {1'·· r:1·- m·,-e · . n · ; . · a · • : r . , o e n · 1·1llie· · ["r~, . P . ' . · '' "·1 t; ~ . . , ~ . ~. ' , ·a·nClr:a ~! l:it ~· ~ );~ t.,~-~ •

't;,:.'~ l1i 1 ·t, iv-, l1í••it1J;~ ~ 11 l , , · · ::~ . i ~- . , . "· . , !" e .,L • L . . -·-· · - · - -. . --1· . , (.~· ,-.y 1· • .:e-:: .; . -~ - . - ~ · :,· t :l:·=; ~~ :-~. , --- - . ' . 1.,, , , , ,: · ,; , , -~ / ," k :.-, --::0-l! ~., ,, • :,,: . ,"1;;~ •· ~,, JL - - : ;<,'·.·;,: , . . . - . - 1 -. ~k · . ,· • -·· · · , , .,-,; ., ·---· <::'-~!t,:«: . -se:. ~--- ~ ~. ~- . -.A :-·: :--.,·r;: 1 - . (" ·:;t · i ;~ ·Y•'.- -- ~·-•r·•; . ,,., · , . "i· ·1 ~-a·'ffic-.::,;: , , i 'i . -~ . - - . . Fixation(External Method): External fixation Used far fracture.:s that are· tao unstable far a cast. You can showet and us.e the hand gently with the extern-al fixator in 1aee. -L~ P . -.--· ·-- ·--· ~--• : . te ~ 1. :-: - Fixation

(External Method): Traction .,, ~ . .1·~·• . r