fracture healing majuuuu

7/18/2019 Fracture Healing Majuuuu

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FractureHealing

Ratna Astri AndhiniYoan Putrasos ArifLeidya Valentina


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FRACTURE HEALING

Fracture healin is a tissue reeneration !rocess rather than ahealin !rocess the in"ured #one is re!laced #y #one$

The !rocess of re!air %aries accordin to&

'The ty!e of #one in%ol%ed$

'The a(ount of (o%e(ent at the fracture$

'The closeness of the fracture surfaces$

In tu#ular #one the !attern of re!air sho)s stri*in di+erence than

cancellous one$T)o ty!es of tu#ular #one re!air&

, Healin #y callus

, Healin )ithout callus

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-taes in the Healin of a .oneFracture /healin #y callus0

1D - Hematoma formation (brin mesh)

4D - Inammation PDGF I! "GF

1# - $oft callus granulation matri%&

'# - allus ossication o*en bone

+# - ,e-moeling absorb.e/osit strengthlamellate&

3

Hematoma

Externalcallus

Bonycallus ofspongybone

Healedfracture

Newbloodvessels

Internalcallus(fibroustissue andcartilage)

Spongybonetrabecula

Hematomaformation

Fibrocartilagecallus formation

Bony callusformation

Bone remodeling


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Healing by Callus

1. Tissue Destruction and Hematoma Formation

Fracture damages the bone, blood vessels,

bone matrix and surrounding soft tissue

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Hematoma

Hematoma

formation

Disruption of blood vessels hematoma forms around and

!ithin fracture

Fe! millimeters of the fracture

surfaces dies.


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Healing by Callus

". #nflammation and subperiosteal and

endosteal cellular proliferation

$

5/30/15referat traumatologi

Hematoma

Hematomaformation

%eed & hours. 'roliferation of fibroblasts, mesechymal cells, and

osteoproginetor cells.

%e! vessels formation.


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In1a((atory Phase6


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Fibrocartilage callus formation

#nflammatory %ecrosis Tissue and (xudate )esorbed

Fibroblast help form chondroblasts and collagen fibers

'roduce ne! matrix

*The fracture callus+

Healing by Callus

Hematoma

Externalcallus

Newbloodvessels


Spongybonetrabecula

Hematoma

formation

Fibrocartilage

callus formation


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2$ Callus For(ation


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Hematoma

Externalcallus

Bonycallus of

spongybone

Newbloodvessels


Spongybonetrabecula

Hematoma

formation

Fibrocartilage

callus formation

Bony callus

formation

Chondroenic and osteoenic acti%ity$

Cartilae in the !eri!hery3 )o%en #one near the #oneends$

4ar*ed increase in %ascularity$

5steoclast acti%ity$

At the end the !ain disa!!ears and the fra(ents are riid)6o (o%e(ent$

Healing by Callus


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7$ Consolidation

The !ri(iti%e )o%en #one is transfor(ed intola(ellar #one #y osteoclastic and osteo#lasticacti%ity$

Need se%eral (onths #efore the #one is stronenouh to carry nor(al loads$

9Healing by Callus


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8$ Re(odellin

Re(odellin of the )o%en #one is de!ent on the (echanicalforces a!!lied to it /9ol+:s La)0

Cortical #one re(odellin occurs #y in%ation of and osteoclast)hich is then follo)ed #y osteo#iast )hich lay do)n ne)la(elar #one


10Healing by Callus


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8$ Re(odellin

Consist of osteo#lastic and osteoclastic acti%ities that resultre!lace(ent of the i((ature #one to (ature #one

4edulary canal radually refor(s

Correction of anular defor(ities #ut not rotational defor(ities


11

Hematoma

Externalcallus

Bonycallus ofspongybone

Healedfracture

Newbloodvessels


Spongybonetrabecula

Hematoma

formation

Fibrocartilage

callus formation

Bony callus

formation

Bone remodeling


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12

Inflamation

SoftCallus

HardCallus

Union

PD!" #!#$!"I$#%&'%U(I$

)S#%)C'*S#

!I+&)+'*S#"

CH)$D&)+'*S#

)S#%)+'*S#

,)D%''I$

&%,)D%''I$


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Healin Ti(e in adult13

Falan6(eta*ar!al6(etatarsal6*osta

;istal radius;ia

? '?@?@ '?>B ' ??@ '

?>

-ees

-ees-ees-ees-ees-ees-ees

-ees-ees-ees

')C*#I)$ H(/#%0 T#(


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Healin )ithout Callus

Callus is for(ed as a res!onse to (o%e(ent at thefracture side3 to sta#ilie the fra(ents riidly$

Pri(ary #one healin occurs directly #et)een the @fra(ents )ithout callus for(ation3 )hen the fracture siteis a#solutely i((o#ile$

Pri(ary #one healin can occur in @ instances&, Naturally in i(!acted fractures of the cancellous #one$

, In cortical fractures )here the @ fra(ents are inco(!lete contact and riidly


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Healing of Fracture inancellous 0one

Cancelous #one has s!onyteDture )ith o!en (esh)or* oftra#eculae3 allo)in easier

!enetration #y %essels and #onefor(in cells$

The #roader area of contact

#et)een the fra(ents )ith ood#lood su!!ly allo) healin inshorter !eriod of ti(e )6o needfor callus for(ation$

5/30/15 referat traumatologi 15


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Healing of fracture in articularcartilage

The hyaline of "oint surface iseDtre(ly li(ited in its a#ilityto either heal or reenerate

Articular cartilae heals #y


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Factors in1uencin #one

healin

Local FactorsThe deree of local trau(a

The deree of #one lossThe ty!e of #one in%ol%ed

The deree of i((o#iliation

Infection

Local (alinancy

5ther local !atholoic condition

Inta articular fractures

1.


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The deree of local trau(a

The soft tissueen%elo!e around thefracture (ust in thisinstance heal the softtissue the(sel%es as)ell as !ro%ide

(esenchy(al cells forfracture healin

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The deree of #one loss

Loss of #one su#stance oreDcessi%e distraction of thefra(ent leads to a

condition in )hich the cellsa#ility to #ride the a! isco(!ro(ised

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The ty!e of #one in%ol%ed

Re!air of cancellous#one is ra!id #ecausethere (any !oint of#one contact rich of#lood su!!ly

Cortical #one healin

de!ends on deree ofi((o#iliation

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The deree of i((o#iliation

In adeuatei((o#iliation leads todelayed union or nonunion

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Infection

If there is an infectionthe local defenses arei((o#ilied all or in !artto atte(!t to )all o+ andeli(inate the infection

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Local (alinancy

The (alinant cells!recludes a+ecti%ei((#oliation of the

fractures

The (alinan lesion is aneD!andin one in )hichthe de!osite actually

eDtends into the areasfro( )hich healin (ustta*e !lace

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5ther local !atholoic

conditionsPaet:s disease or


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Intra articular fracture

-yno%ial 1uid contain


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Ae of the !atient26

F!"#$E HE!%IN&

OSTEOGENIC

ACTIVITY

PERIOSTEUM

AND

ENDOSTEUM

REMARKABLY RAPID AT BIRTH

LESS RAPID EACH YEAR OF

CHILDHOOD

RELATIVELY CONSTANT FROM

EARLY ADULT LIFE TO OLD AGE


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Hor(ones

2.

Hormones %ffet ,eanism

Cortisone Decr Decreased callus productionCalcitonin #ncr 2no!n

TH3'TH #ncr one remodelling

0H #ncr #ncreased callus volume

ndrogens #ncr #ncreased callus volume


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Diagnostic of fracture

healing

the fracture healin !rocess a!!recia#le #y &

?$ clinical eDa(ination@$ radioloy eDa(ination

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Clinical eDa(ination


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!''% # #HE

F!"#$E*

BENDING

TWISTING

COMPRESSION

FORCES

to determine whether or not a

movement


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02DI2G "$" (antero/osterior)

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02DI2G "$"( !ateral0

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T9I-TING TE-T

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C54PRE--I5N TE-T

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CLINICAL UNI5N

45VE4ENT AT FRACTURE -ITE /'0

PAIN /'0

3-


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,3DI!GI3!

536I23"I2

linical union7

bon8 callus fracture line (9)

,aiological union7

allus briging the fracture sie trabecular continuit8at fracture site fracture line (-)

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CLINICAL UNI5N

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RA;I5L5GICAL UNI5N

3.


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P2:60;H32 302,63!F,3


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63! ;2I2

FRA=TUR -E4.UH ;ALA4 9A=TU YANG

N5R4AL TAPI PA;A P5-I-I YANG ELE=;ENGAN ;EF5R4ITA- RE-I;UAL

;EF5R4ITA- RE-I;UAL & ANGULA-I3R5TA-I3 -H5RTENING3 LENGTHENING

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P2:030 63! ;2I2

FRA=TUR YANG TI;A= ;ITIN;A=I

PENG5.ATAN YANG TI;A= A;E=UAT

REP5-I-I 6 I45.ILI-A-I TI;A= A;E=UAT

5-IFI=A-I PRE4ATUR LE4PENG EPIFI-I-

-0


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=2I$ 22 ;2I2

FI0,;$ 22 ;2I2

Terda!at "arinan


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=2I$ 22 ;2I2

HIPERTR5PI=

U"un fra(en tulan le#ih #esar dari nor(al / ele!hant:s

foot 0

ATR5PI= 6 5LIG5TR5PI=

U"un fra(en tulan le#ih *ecil dan #ulat sertaosteo!oroti* dan a%as*uler

50


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P2:030 22 ;2I2 Inter!osisi "arinan luna*

Vas*ularisasi yan *uran

Redu*si yan tida* ade*uat

I(o#ilisasi yan tida* ade*uat

Fi*sasi interna yan tida* ade*uat

;estru*si tulan oleh tu(or atau infe*si

Terda!at "ara* yan #esar antara fra(en

51


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22;2I2 3


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22;2I2 3


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N5NUNI5N A=I.AT INFE=-I

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N5N UNI5N A=I.AT INFE=-I

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P2:60;H32 F,3


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P-EU;5ARTR5-I-

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F,3


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F,3


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F,3


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fracture healing majuuuu

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