Which Of The Following Choices Have The Steps Of A Bone Fracture Repair In The Correct Order?
6.5 Fractures: Bone Repair
Learning Objectives
By the finish of this section, you will be able to:
Explain how bone repairs itself after a fracture
- Differentiate among the dissimilar types of fractures
- Describe the steps involved in bone repair
A fracture is a broken bone. It will heal whether or not a doctor resets (places) it in its anatomical position. If the os is non reset correctly, the healing procedure will rebuild new os just keep the bone in its deformed position.
When a broken bone is manipulated and ready into its natural position without surgery, the procedure is called a closed reduction. Open reduction requires surgery to betrayal the fracture and reset the bone. While some fractures can exist pocket-sized, others are quite severe and issue in grave complications. For example, a fractured diaphysis of the femur has the potential to release fat globules into the bloodstream. These can go lodged in the capillary beds of the lungs, leading to respiratory distress and if not treated quickly, death (this is called a pulmonary embolism).
Types of Fractures
Fractures are classified past their complexity, location, and other features (Figure 6.v.1). Table 6.4 outlines mutual types of fractures. Some fractures may be described using more than one term because it may have the features of more than one type (due east.g., an open up transverse fracture).
| Types of Fractures (Table half dozen.iv) | |
|---|---|
| Type of fracture | Description |
| Transverse | Occurs straight beyond the long axis of the os |
| Oblique | Occurs at an angle that is not 90 degrees |
| Spiral | Os segments are pulled apart as a result of a twisting motility |
| Comminuted | Several breaks effect in many small pieces between two large segments |
| Impacted | 1 fragment is driven into the other, normally as a result of pinch |
| Greenstick | A partial fracture in which merely ane side of the bone is broken, often occurs in the immature |
| Blazon of Fracture | Clarification |
|---|---|
| Open (or chemical compound) | A fracture in which at to the lowest degree 1 terminate of the broken bone tears through the skin; carries a loftier hazard of infection |
| Closed (or simple) | A fracture in which the skin remains intact |
Os Repair
Depending on the blazon, severity of the fracture and distance betwixt bone fragments, bones may heal direct by building new bone onto the fracture site (direct os healing or contact healing) or may heal in a process like endochondral bone formation (indirect bone healing). Direct bone healing is essentially bone remodeling in which osteoblasts and osteoclasts unite broken structures. With indirect bone healing the procedure is more complicated and similar to endochondral bone formation in which broken bones form cartilaginous patches earlier regrowing new bone. In this procedure, blood released from broken or torn vessels in the periosteum, osteons, and/or medullary cavity clots into a fracture hematoma (Figure half dozen.5.iia). Though cleaved vessels promote an increase in nutrient delivery to the site of vessel injury (encounter inflammation procedure in blood vessel affiliate), the disruption of claret menstruum to the bone results in the expiry of bone cells around the fracture.
Within about 48 hours after the fracture, stem cells from the endosteum of the os differentiate into chondrocytes which then secrete a fibrocartilaginous matrix between the two ends of the broken bone; gradually over several days to weeks, this matrix unites the opposite ends of the fracture into an internal callus (plural = calli or calluses). Additionally, the periosteal chondrocytes form and working with osteoblasts, create an external callus of cartilage and bone, respectively, around the outside of the break (Effigy half-dozen.five.twob). Together, these temporary soft calluses stabilize the fracture.
Over the next several weeks, osteoclasts resorb the dead bone while osteogenic cells become active, separate, and differentiate into more osteoblasts. The cartilage in the calluses is replaced by trabecular bone via endochondral ossification (destruction of cartilage and replacement by bone) (Figure 6.five.2c). This new bony callus is also called the difficult callus.
Over several more than weeks or months, meaty bone replaces spongy bone at the outer margins of the fracture and the bone is remodeled in response to strain (Figure six.five.2d). Once healing and remodeling are consummate a slight swelling may remain on the outer surface of the bone, but quite often, no external evidence of the fracture remains. This is why os is said to be a regenerative tissue that can completely supervene upon itself without scars.
External Website
Visit this website to review different types of fractures then accept a short self-cess quiz.
Section Review
Fractures are classified by their complication, location, and other features. Mutual types of fractures are transverse, oblique, spiral, comminuted, impacted, greenstick; they may also be classified as open (or compound), and closed (or uncomplicated). During indirect bone healing, fracture repair begins with the formation of a hematoma, followed past cartilaginous internal and external calluses. Osteoclasts resorb dead bone, while osteoblasts create new bone that replaces the cartilage in the calluses. Calluses eventually unite, and bone remodeling occurs to consummate the healing procedure.
Review Question
Critical Thinking Questions
1. What is the difference betwixt closed reduction and open reduction? In what type of fracture would closed reduction near probable occur? In what type of fracture would open reduction most likely occur?
2. In terms of origin, composition and cells involved, what are the differences between an internal callus and an external callus?
Glossary
- closed reduction
- manual manipulation of a broken bone to set it into its natural position without surgery
- external callus
- collar of cartilage and bone that forms around the outside of a fracture
- fracture
- cleaved bone
- fracture hematoma
- blood clot that forms at the site of a broken bone due to cleaved claret vessels
- internal callus
- fibrocartilaginous matrix, in the endosteal region, between the two ends of a broken os
- open reduction
- surgical exposure of a bone to reset a fracture
Solutions
Answers for Disquisitional Thinking Questions
- In airtight reduction, the broken ends of a fractured os can be reset without surgery. Open reduction requires surgery to return the broken ends of the bone to their correct anatomical position. A partial fracture would likely require closed reduction. A compound fracture would require open reduction.
- The internal callus is produced by cells in the endosteum and is equanimous of a fibrocartilaginous matrix. The external callus is produced past cells in the periosteum and consists of hyaline cartilage and bone. Both types are formed by stalk cells that differentiate into chondroblasts (chondrocytes), just in dissimilar locations.
Source: https://open.oregonstate.education/aandp/chapter/6-5-fractures-bone-repair/
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