A Lecture on Fracture Healing / Healing of Bone Fracture for UG BAMS Shalya/MBBS/BHMS/BHMS/ Nursing


after this epiphysial injuries,  there is
another important topic which is asked for 5 marks for your exams  that is about  healing
of the bone fracture healing of the bone fracture right   so you have heard or you studied
about  how the healing takes place   in case wound, Varna  is over know,  so how
the healing takes place,  healing of the wound,  or stages of healing,  or phases
of healing,  there are  some stages or phases of  healing know,  like that only, 
here also,   there are  some of the phases or  stages of healing of that particular
bone  fracture. so whenever there is a fracture it should  heal   right it should heal, 
so healing will takes place in stages  or we can say in  phases,  right,   generally 
the healing of the fracture bone  explained in  3 stages,   first second third,  
it is related with the three R’s. R R R… The first phase of healing of fractured
bone is, the phase of reaction,   stage of or phase of reaction, right.  Here, there
will be the reactionary phase, there is some sort of reactions going on just after the
fracture, just after the discontinuity of the bone is there, and then, there is some
sort of reactions going on.  It is the first phase is related with the reaction.   In
this reaction phase, again it is of two sub phases, as first stage is stage of Hematoma
formation.  Hematoma formation.  right, there are  generally three phases,   right,  
Among   3  phases,  First phase is stage of or  the  phase of  reaction, in that 
first stage there is another stage,  it is stage of Hematoma formation,  so whenever
there is  a fracture or discontinuity in the bone,  right,  it might be because of
any cause,  so whenever there is a  fracture, in first phase of fracture what happens, 
there will be the stage of Hematoma formation, means the  blood will Rush in  between the
fractured segments or the fractured fragments, whenever there is a fracture,  if there is
a gapping in between  the bone,  then what happens  there will be the collection of
blood, right,  it is called as  stage of Hematoma formation,  after accumulation of
this blood along with the exudates,  exudates means,  some of the,   some  sort of secretions
which are taking place,  or which are gathered in between the fractured segments of the bone,
right,  there is  some sort of  exudates or secretions along with the blood,  it will
make the first stage,  that is the stage of Hematoma formation.   means here there
will be  the collection of blood,  along with the collection of blood there is some
sort of  exudates or secretions which are related with the surrounding  tissues,  
soft tissues, or  if there is  injury to the soft tissue all those tissues secrets
some sorts of  secretions.  Right.  Those secretions might be containing the WBC cells,
WBCS or RBCs, or different plasmas,   lymph fluid or anything, any secretion.  So all
these  secretions along with the blood, they will be collected  in between the fracture
segments.  Here there is a fracture segment and here also there is a fracture segment.  consider
this as a fracture,  so if there is any fracture, right, if there is a fracture in between these
things,  what happens,  there is the collection of the blood,   so whenever there is a collection
of the blood  in between the fractured segments, then what happens,  it will fill the gap, 
in between the fractured segments,  so there is a gap no so that gap will be filled by
the secretions along with the blood, so all these secretions  and the blood  will 
come and accumulate  in between the fractured segments or in between the gap,  so this
stage is called as the stage of Hematoma formation, as it is having the accumulation,  that accumulation, 
the accumulated blood will be  clotting, as it is coming out of its circuit,  right, 
so what happens,  there will be some sort of  clotting,  that clotted blood is called
as  Hematoma.  So this is the first stage, where in there will be the stage of the Hematoma
formation.  Means the haematoma will be formed, this is the first stage, this stage is in
the reaction, means here there is some sort of reaction which is occurred because of the
fracture, so whenever there is a fracture, this is a reaction protect to that particular
fracture. So it is in the reaction phase, and this stage is called as stage of Hematoma
formation.  so after this stage of Hematoma formation  there is a 2nd stage,  where
in there will be some sort of proliferation of the cells,   proliferation means  Pro
life ration,  pro  means, it is related with the  professionalism,  or with the
extra activity  or with the extra knowledge or  intelligence or whatever it is,  it
is some sort of  extra,  it is  Pro. Right.   life ration,  life means it is
giving the life 2 particular part,  ration means it is the process,  so where in there
is some sort of extra growth,  it is called as proliferation,  right.  So in second
stage what happens, where will be the stage of Cellular proliferation.   Proliferation
means what it is there is some sort of the extra Cellular growths in between this fractured
segment,  right.  so as this Hematoma is formed just after the fracture,  right, 
just after the fracture what happens, there is the  Hematoma,  in that Hematoma there
is some sort of changes,   it is called as changes in between the cells,  or types
of cells,  it is called as metaplasia, Plasia means, cells it is,  related with the changes
in the cells,  or metaplasia means,  changes in the types of cells,  these blood cells
these clotted blood cells or exudates will start slowly changing towards the  chondroblasts, 
chondroblast means,  Condra is the world which is related with the cartilage,  right, 
here the  hematogenous cells which are clotted cells or blood cells or exudates  or the
lymphatic fluids,  all these  cells  will start slowly converting into chondroblasts. 
Right.  So chondroblasts will be formed, this haematoma is converted into the chondroblasts, or
there will be the changes in the cells, it is called as the metaplasia, right.   Metaplasia
means changes from one type of cell to the cell, it is metaplasia.  so here what happens, 
hematogenous cells or blood cells or  exudates are changing in to  the chondrocytes  or
controblasts,  blasts generally the word is used for the growth cells which are having
the growth,  or which are having the capacity to regrow,   or which are having the capacity
to grow The Other cells are called as blasts. right,  osteoblasts,  means osteoblasts
are cells having the capacity 2 regrow or give the birth to the new cells, right, so
those are called as blasts, right, erythroblasts, erythroblasts means, those which are giving
the birth to blood cells, or, to give the birth to the new cells, right, those are called
as blasts, right, erythroblasts, erythroblasts means, those which are giving the birth to
blood cells, or the erythrocytes, or the RBC’s, growing cells, erythropoietin, so, blastic
means they are giving birth to the new cells, right, so here, the chondroblasts means, the
chondra will be formed, means there should be the formation of this cartilaginous structure,
in between this, or conversion of, after conversion of this hematogenic cells, or blood cells,
being converted in to the cartilaginous cells, right, so whenever this stage is there, this
stage is called as second stage, that is the stage of cellular proliferation, means new
cells are growing, this is also in the phase of Reaction, right, in the second phase, there
is a stage of Repair, R E P A I R, ok, this is the second phase, the stage of repair,
means repairing of the cells will be takes place, right, repairing of the, repairing
of the cells will be takes place, in this phase, here what happens, there is a stage
of, again two stages here also, stage of callus formation, callus formation, callus formation
means, callus is one of the hard tissue, or newly formed tissue, right, callus means it
is the hard tissue, or newly formed tissue, which is related with the osteoblasts, or
osteo cells or osteocytes, right, means, osteo means it is the word related with the bone,
so new bone cells are formed in this stage, a callus means, the stage of new bone, right,
new bone tissue or new bone cells, here in this stage what happens?, there will be the
repair, how it is repairing, there cellular stage, that is the chondroblasts are gradually
converting in to the osteoblasts, right, chondroblasts, so this osteoblasts, chondroblasts, before
that there will be the stage of haematogens, or blood cells, so all these are the conversion
from, starting with the blood to, till the osteoblasts, right, so blood to converted
in to some sort of new cells that is chondroblasts, after this chondroblasts , this is the, next
stage is the osteoblasts, so, this system which is adding the fibrils, of the fibers
in between, the fibers of the chondra or the cartilage, the fibers of the bones, all these
in the new stage is called as the haversian system, haversian system, H A V E R S I A
N system means, is the newly formed cells (osteons) or not complete adult bone cells,
it is new cells, new cells of the bones, right, wherein, they will going to form the adult
bone cells, so those are the system (columns) of the cells (osteons), or combination of
different cells, are called as haversian system, right. So here, we are seeing the callus formation,
so callus means what it is?, it’s the new bone, new bone tissue which is newly formed,
it is called as callus, right. So in the stage of callus formation, here what happens? There
will be the formation of callus; means generally the chondroblasts are converting in to the
osteoblasts, right. So bone cells are forming, this is the stage. Here in this callus formation
stage, again there are three different stages, that is internal callus, external callus,
and the intermediate callus, there are again three stages that is, internal callus, external
callus, and the intermediate callus, callus is formed, how the callus is formed?, in between,
in the three stages, externally also there will be the formation of the callus, internally
also there will be the formation of this callus, and in between the external and the internal
layers, there is again the callus formation, right. Externally means on the outer layer
of the bone, on the cortical bone, there will be formation of or gaping will be filled,
means how the gaping will be filled? It will be filled by the again new cells, new osteoblasts,
right, they will be filled externally in the cortical layer, internal callus formation
means, internally what will be there? In the long bones, there will be the bone marrow,
in the adults there will be the bone marrow, right, which bone marrow it is, generally,
it’s of yellow bone marrow, right. So this yellow bone marrow will be replaced with this
internal callus, right, the yellow bone marrow will be replaced with this internal callus
and there is no gap, as there is no any narrowing, because of the fracture there will be the
gap, that gap will be filled by the haematoma, that haematoma will be filled by this, callus,
internally, in the internal part, in the hallow part of that bone, there will be the formation
of this callus, internal callus, which is replacing, which will be replacing the yellow
bone marrow, in case of adults, right. So intermediate, intermediate callus means, it
is the callus which is present on the spongy part of the bone or the callus part of the
bone, that callus part of the bone will be filled by this intermediate callus, and also
externally, external callus will be filled in the cortical bone tissue, right, that will
be it is called as external callus, so this is the stage of callus formation. After this
stage of callus formation, there is the new bone tissue formation, actually the callus
is also the new bone but the adult bone cells will be formed in the next stage, after the
stage of callus formation, right, this is also in the phase of repair, right. So after
this repair, that third phase or the last phase is the phase of remodelling, the Remodelling,
means reshaping of that particular bone, fractured bone, how it is? Generally in case of the
children what happens, if there is any angular deformity, if there is any angular deformity,
while joining if the ones, fractured segments if there is any angular deformity, that angular
deformity will be replaced, or that angular deformity which has been formed, that will
be remoulded or reshaped into the normal one, to make it into the Normal alignment, right,
so the normal alignment will be formed in this stage, that is, in this phase, that is
the phase of remodelling, means extra cells which is having the callus, the callus will
be formed know, external callus will be replaced with the normal tissue, the extra bone tissues
will be there know, that callus will be replaced, it will be remoulded, in case of children,
the axial rotation if there any, present, that axial rotation will remoulded or it will
be in the alignment, if there is any axial rotation, but in case of adults, the axial
rotation will not be replaced, will not be remoulded or reshaped, it will remain as it
is. The axial rotation, is there any, present, in case of Adults, in the fractures, it will
not be remoulded or reshaped, only the angular deformity will be reshaped or normalised,
in case of adults, where as in children the axial rotation is also reshaped or remoulded
along with the angular deformity, if there is any angular deformity, that deformity will
also be replaced or normalised, if there is any axial deformity that deformity that deformity
is also normalised in case of children, means, as they are having the growth phase, but in
case of adults, only the angular deformity will be replaced by the stage of remodelling,
or by the phase of remodelling, here in the phase of remodelling and internal callus,
what I said, it will be replaced with generally the soft adipose tissue, which will going
to be the yellow bone marrow, the internal callus will be replaced, in the stage of remodelling
what happens? The internal callus which is formed will be replacing the adipose tissue,
adipose tissue will be there, after that adipose tissue, it will be converted in to the yellow
bone marrow, right. So these are the three phases of healing of the fractured bone, right,
it can be studied in three phases or five stages, right. The first stage is the stage
of Haematoma formation, second stage of cellular proliferation, the third stage is the stage
of callus formation, fourth is the stage of new bone generation or new bone formation,
and the fifth is the remodelling stage, if we are saying that it is having three phases
then, it will be of phase of reaction, the phase of repair, and the phase of remodelling,
ok. Any doubt? Ok. Thank you.

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