Orthopedic Care and Consultation
Fifty six years old lady injured her arm in a motor vehicle accident and xray revealed spiral fracture of humerus.
Spiral Fracture of Lower Third HumerusThe Fracture Operated and Fixed Using Narrow DCP and Interfragmentary screw
The fracture was treated by open reduction and internal fixation using locking compression plate and interfragmentary screw. [Read more...]
This photograph is of forearm of 54 years old patient who was admitted to the hospital for some medical problem.
The deformity in the left forearm was quite prominent.
She gave a history of trauma19 years ago and there was fracture of both the bones [radius and ulna]. The fracture was managed by an osteopath because she refused to take operative treatment.
Interstingly, the fractured fragments were mobile and I wanted take an xray picture to look for pseudoarthrosis but she refused.
Also, in the picture, you can see patchy skin depigmentation.
A hematoma is a mass of clotted blood that forms at an injury site.
A fracture hematoma is a clot resulting from a break in a blood vessel within the bone, the marrow space, the periosteum, or the surrounding tissue associated with a bone fracture.
Until the fracture communicates with exterior or in some special cases internal organs like viscera, the fracture hematoma surrounds the fracture.
Fracture hematoma plays an important role in bone healing.
Primary Bone Healing
In this kind of healing callus is not formed at all and requires rigid stabilization with or without compression of the bone ends.
Rigid stabilization suppresses the formation of a callus in either cancellous or cortical bone .
Because most fractures are managed in a way that results in some degree of motion, primary healing per se is rare.
Primary bone healing can be divided into gap healing and contact healing. Union occurs in both types. [Read more...]
Fracture of shaft of humerus is very amenable to treatment but a percentage of fractures do not heal. Normal healing of a humeral fracture occurs over 8 to 10 weeks. If the fracture has not achieved union by 3 to 4 months, it can be considered a delayed union. If union does not occur by 6 to 8 months it is called non union of the fracture.
Non unions are two types
Hypertrohic occurs due to increased vascularity which allows abundant callus to form. The callus formed has insufficient stability to prevents union. [Read more...]
Both local and systemic variables influence the rate and degree of fracture healing. When normal healing occurs, but at a slower rate than usual, it is termed delayed union. A complete cessation of the healing process, in which fibrous tissue is never replaced by bony matrix, is termed nonunion. [Read more...]
Healing of a fractured bone is quite a complex process.
To understand the process better we need to have an idea about the anatomy of the bone.
Bone is surrounded by a thin membranous layer of tissue called periosteum ( See adjoining Figure – The figure represents a cut section through a bone. Normally the bone is like a cyllinder. Imagine cyllinder cut into halves along its longitudinal axis and you would get a similar picture. ).
When bone breaks, it bleeds from its torn ends due to disruption of its supplying vessels.
Quite naturally the periosteum also is torn as shown in the figure. This periosteum may be completely torn or partially damaged depending upon the force of injury.
The collected blood is called fracture hematoma. [Read more...]
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