Osteology – Healing of Fractures

Osteology – Healing of Fractures

• 5 histologic stages of fracture healing:
1. Fracture
2. Formation of granulation tissue around
fractured bone ends
3. Replacement of granulation tissue by callus
4. Replacement of callus by lamellar bone
5. Remodeling of bone to normal contour
Osteology – Healing of Fractures
1. Fracture
2. Formation of Reactive phase
granulation tissue
3. Replacement of
granulation tissue
by callus Reparative phase
4. Replacement of
callus by lamellar
bone
5. Remodeling of
bone to normal Remodeling phase
contour
Osteology – Healing of Fractures
• Fracture causes haemorrhage and tissue
destruction; blood clot forms (hours)
• Proliferating fibroblasts and capillary
sprouts grow into blood clot in injured area,
forming granulation tissue, in response to
cytokines released by tissue damage (days)
Fracture Healing

Haemorrhage

Tissue destruction

Proliferating fibroblasts
and capillary sprouts grow
into blood clot in injured
area, forming granulation
tissue

Modified from Junqueira

Osteology – Healing of Fractures
- continued
• Invaded by polymorphonuclear leukocytes,
macrophages (also responding to
cytokines), which phagocytize debris (blood
clot, cells, damaged matrix)
• Granulation tissue becomes denser
• Cartilage formed (? from primitive
mesenchymal cells or demodulation of other
cells) (weeks)
Fracture Healing

Invaded by neutrophils,
macrophages which
phagocytize debris

Granulation tissue
becomes denser

Cartilage forms

Modified from Junqueira

Osteology – Healing of Fractures
- continued
• Connective tissue + cartilage tissue = callus
• Callus temporarily binds, stabilizes bone
• Dormant osteogenic cells of periosteum
enlarge and become osteoblasts
• Osseous tissue deposited on outside of bone
some distance from fracture
• Formation of new bone continues toward
fractured ends of bone
Fracture Healing
Connective tissue
+
Cartilage tissue
=
Callus

Callus temporarily binds

and stabilizes bone

Dormant osteogenic cells of

periosteum enlarge, become
osteoblasts, deposit osseous
material on outside of bone
centripetally

Modified from Junqueira

Osteology – Healing of Fractures
- continued
• U.S. Civil War studies quoted by Norman
Sauer (in Forensic Osteology, 2nd edition,
K. Reichs, ed.), macroscopic evidence of
bone healing is seen as early as 7 days post
injury, and on average is seen at 13 days
post injury
Osteology – Healing of Fractures
- continued
• Finally forms sheath of bone over fibro-
cartilaginous callus (1-2 months)
• Osteogenic buds invade fibrocartilaginous
callus and replace it with bony callus
• In replacement of fibrocartilaginous callus,
cartilage undergoes calcification and
absorption same as intracartilaginous bone
formation
Fracture Healing

Sheath of bone is formed

over fibrocartilaginous
callus; osteogenic buds
invade this callus and replace
it with bony callus; in replace-
ment of this callus, cartilage
undergoes calcification and
absorption same as in
intracartilaginous bone
formation

Modified from Junqueira

Osteology – Healing of Fractures
- continued
• Intramembranous bone formation also
occurs
• When subperiosteal bone formation is
occurring, medullary bone forms
centripetally from both sides of fracture,
aiding bony union (Junqueira); Cormack
indicates that medullary bone forms
centrifugally
Summary diagram of bone healing

From Cormack
Fracture Healing

From Junqueira
Osteology – Healing of Fractures
- continued
• Process varies with degree of displacement
of fractured ends of bone and degree of
trauma inflicted
• Uneven or protruding surfaces are gradually
removed and healed bone, especially in
young individuals, assumes its normal
contour – remodeling (months to years)
(Junqueira)
Fracture Healing

From Junqueira
Summary diagram of bone healing

From Cormack
END