Causes, types of fractures and phases of healing
Content:
- What is a bone fracture?
- Fracture causes
- Types of fractures
- Fracture healing phases
- Treatment
What is a bone fracture?
Fracture is the destruction of the bone followed by the separation of the parts. It can be caused by a shock or various swelling or inflammation.
There are several complications that can arise after a fracture:
- as soon as the bone collapses, its fragments can damage soft tissues, which will lead to additional injuries and bleeding;
- paralysis may occur due to damage to nerve cells by fragments of bone or the bone itself;
- with open fractures, the risk of infection increases with subsequent purulent inflammation;
- a fracture can lead to injury to vital organs such as the brain if the skull is injured or broken, or the lungs, heart, etc., if the ribs are broken.
Fracture causes
Fractures can be divided into two large groups. The cause of the fractures of the first group is the effect on the bone of various forces: fall, blow, and more. The cause of fractures of the second group is the weakening of the bone itself and its fragility.
In the second type, the risk of fracture increases several times. It even comes to the point that when walking, a person can also break his leg. The reason here is that this is a pathology of the bone itself, and not an external influence on it. It is often influenced by various diseases such as osteoporosis and various tissue tumors. If you have osteoporosis, then, as mentioned above, it may be enough for you to just stand up and your bone may break. Hip fractures are very common in older people. As for open fractures, they most often occur in the places of the lower leg, that is, the legs, and it also happens on the hands, where the layer of skin is thin. If you fall from a height, then most likely there will be a fracture of the spine or chest, that is, the ribs.
Types of fractures
There are two types of fractures: traumatic and pathological fractures:
- Traumatic fractures appear due to the fact that a short but powerful enough force acts on the bone.
- Pathological fractures are the action of various diseases that affect the bone, destroying it. The turning point in this case happens by chance, you don't even notice it.
Also distinguish between open and closed fractures:
- Closed fractures are usually not visible, and deformation of the skin due to splinters does not occur.
- As for open fractures, the opposite is true. As soon as an open-type fracture occurs, an infection immediately enters the wound, which can subsequently spread throughout the body. Fractures of the gunshot type are very rare for the common people, but such fractures also exist.
Also, fractures can be divided by how many parts the bone has broken or displaced (fracture with and without displacement)
Fractures can be subdivided according to the very shape of the fracture, based on the direction of the fracture line into:
- Transverse
- V-shaped
- Helical
- Oblique
- Longitudinal
- T-shaped
There may also be fractures by bone type:
- Hip fracture
- Broken arm
- Fracture of the radius
- Leg fracture
- Spine fracture
- Tailbone fracture
- Clavicle fracture
- Shin fracture
- Humerus fracture
- Jaw fracture
- Broken nose
- Fracture of the foot
- Fracture of the pelvis
- Skull fracture
- Fracture of the tibia
Fracture healing phases
After a fracture, damaged bones in most people grow together in a chondroblastic manner. Chondroblasts are the youngest and most active cells in cartilage tissue. They have a flattened shape, are located inside the perichondrium and throughout the entire thickness of the cartilaginous tissue. At the stage of bone growth and fusion, the process of mitotic division and fermentation occurs in chondroblasts. In other words, a person owes the ability to grow the skeleton and its recovery after injury to chondroblasts.
A cartilaginous callus forms at the site of the fracture. This process lasts several months and includes four main phases.
The first phase is catabolic (7-10 days):
- Aseptic (that is, without the participation of microbes) inflammation develops in the soft tissues surrounding the fracture site;
- Extensive hemorrhages occur;
- Blood circulation in the tissues around the fracture is impaired as a result of blood stagnation;
- Toxic products of aseptic inflammation are thrown into the bloodstream and spread throughout the body, which explains the general poor health of the patient (fever, weakness, chills, nausea);
- Enzymatic cellular activity increases around the fracture site;
- On the surface of the fracture of the bones, necrotic processes occur (microscopic ulceration and areas of death appear);
- There are no signs of fusion of broken bones yet.
The second phase is differential (7-14 days):
- The process of formation of fibro-cartilaginous callus starts (at the site of the fracture, new cells are actively produced: chondroblasts, fibroblasts, osteoblasts, osteoclasts and chondrocytes);
- In these cells, the biosynthesis of glycosaminoglycans (molecules of polymeric carbohydrates) occurs, the main of which is chondroitin sulfate, up to two-thirds of which is contained in young cartilage tissue. Chondroitin sulfate is a substance whose carbohydrate chains are 90% identical to the monosaccharides galactosamine and glucosamine;
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Gradually, the basis of the future bone callus is formed - the metrix. Collagen fibers are actively produced in the cells around the fracture site. At this stage, the callus is still fibro-cartilaginous, that is, there are no channels of blood supplying vessels in it. It feeds on fluid from the extravascular space, which is almost ten times more than in the intravascular space. Due to this difference, the process of osmosis occurs - one-sided diffusion of liquid through cell membranes towards a higher concentration.
The third phase is primary accumulative (2-6 weeks):
- From the surrounding tissues into the fibro-cartilaginous callus, small capillaries gradually grow, which form the vascular network of the future callus;
- Chondroitin sulfate molecules located in the mitochondria of cartilage cells combine with phosphate and calcium ions;
- The regulating enzyme citrate synthetase and the main carrier of energy in cells - adenosine triphosphate (ATP) help the active synthesis of calcium phosphate. Then the chondroitin sulfate molecules combine with calcium phosphate, go out into the extracellular space, and already there react with collagen;
- During this period, the concentration of silicon and magnesium ions in the cartilage tissue also increases. With the participation of these elements from calcium phosphate and collagen at the fracture site, primary bone callus is formed. While it is still very weakly mineralized, does not have an ordered crystal structure and therefore is not strong enough.
The fourth phase is mineralization (2-4 months):
- In the extracellular space of the primary bone callus, a molecular complex of chondroitin sulfate and collagen calcium pyrophosphate is formed;
- These molecules react with phospholipids to form crystalline hydroxyapatite;
- Hydroxyapatite crystals, in turn, settle around the collagen fibers in a special way - so that their axes are located at an angle of 41 degrees relative to each other;
- From this tandem, the first nuclei of bone callus crystallization are obtained. Moreover, they can increase in size, feeding on inorganic ions from the fluid of the surrounding soft tissues. This process is called primary bone mineralization;
- Then secondary mineralization occurs - intercrystalline bonds are formed around the cores. At the end of this stage, we can talk about the complete completion of the fracture healing.
Features of the flow of phases
Above are the averaged data on the course of the course and duration of each phase of bone fusion. The calculations were made on the assumption that we have a relatively healthy patient, and the trauma is not very complex.
But fractures are different, and the speed of recovery directly depends on many factors:
- Fracture type (open or closed, multiple or single, on one bone or several);
- The age of the patient (in older people, bone fusion can last more than six months, and in adolescents it can be completed in a month);
- General health (level of bone mineralization, blood quality, muscle tone);
- The presence or absence of aggravating factors (concomitant diseases and injuries) - the more damage to bones, organs and soft tissues received by the patient as a result of trauma, the longer the rehabilitation process will last.
Treatment
When the fracture is closed, the patient is calmed down with an anesthetic that is injected into the fracture site. The fractured site is reinforced, for example, with a splint, so that the bone and its broken off honor are stationary. If the fracture is open, then the pain is also relieved and the victim is brought to his senses, but only so that he is in adequate condition, then the bleeding should be stopped by clamping the wounds. The bone is also fixed in the splint and the victim is immediately taken to the hospital. If the bleeding does not stop, and this happens with arterial or venous damage, then a tourniquet is applied above the affected area.
Upon arrival at the hospital, the patient will have the bone set, but all this will only happen under complete anesthesia or, for example, anesthesia. If the fracture is not visible enough, the skin is slightly cut. The bone is fixed with plaster.
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At this point in time, all fracture treatment can be divided into two types:
- Conservative - with the same plaster. It was treated like this in ancient times. Now only minor fractures or cracks in the bones are treated this way;
- Operational - the bone can be flattened or pulled with all kinds of knitting needles, tubes, all kinds of chemical elements are also used.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
