Egészségügy | Traumatológia » 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~ll 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:obJTfze··- - - - - 1 1 »"■ -, •. ,<-.· •-·-•-•X ~1-f t7Q;n·e ·r t1111;í""l ~~·11!•1·z.)a:it;·1 {o•n, ~IAu „ro· ;·e;,lfJLW-, !s, n· ·.lO:i;t•· :;: ;~,o ·, c-~c-- -1~ 1rr:• · 1n:,r·a~ . ~",!~ •-1-~~~{i~~ 1 :~ .~•, ; . - 1 rr:1:• ~:, :1tr ~- ~·- ;- -~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·.•;•CXt~,lr!:: Remo de1ing -- ■ Remodeling harci ,/;. callu.§ Jai~Ql: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 1dfR:e "lrf:fi >i ea ör -. tl· .! ,,l ,! t"- tCari :V- }J, ,L.n· ··e ~-~"• : J ., r/f ~1-.~1,star1 , - ✓ (?. ,~ /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 distance (twisting movements) a. 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) : · .-· .: ■ : . ulbaYtielve ·-,.- BT lnitial Treatment o.f

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, , .,-,; ., ·---· <::-~!t,:«: . -se:. ~--- ~ ~. ~- . -.A :-·: :--.,·r;: 1 - . (" ·:;t · i ;~ ·Y•.- -- ~·-•r·•; . ~-a·ffic-.::,;: , ,,., · , . "i·, .·1 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