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FRACTURES of the UPPER
EXTREMITY Questions and Correct
Answers the Latest Update
Generally, fractures heal by _____ in children and ______ in adults
✓ 3-4 weeks
✓ 4-6 weeks
Most important factor in fracture healing is _________.
✓ blood supply
Smoking (nicotine) and systemic diseases (diabetes) have been found to
________ healing time
✓ increase
Inflammatory stage
✓ Development of hematoma and traumatic inflammation
✓ Hematoma is gradually replaced by granulation tissues around fracture ends
✓ Begins immediately after injury and last several days
✓ Swelling and hypoxia are present
✓ Inflammatory cells migrate into the area
✓ Fibroblasts, mesenchymal cells and osteoprogenitor cells present
Reparative stage-organization
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✓ Overlaps the inflammatory stage
✓ Occurs within two weeks of injury
✓ Pain usually decreases in this stage
✓ Union by callus
✓ Direct Healing (Primary Healing)
✓ Indirect Healing (Secondary Healing)
Direct Healing (Primary Healing)
✓ Occurs with rigidly immobilized fractures (i.e., plate and screws)
✓ An implant replaces external callus
✓ Primary healing does not hasten union but ensures it
✓ Union occurs by direct bone healing across the fracture site
Indirect Healing (Secondary Healing)
✓ Motion at the fracture site stimulates healing
✓ Callus formation is stimulated by motion at the fracture site
✓ Enchondral calcification occurs
✓ Fibroblasts and chondroblasts need to be present to sustain the environment long
enough for osteoblastic bone replacement
Indirect Healing (Secondary Healing)
5 factors are necessary:
✓ Hematoma
✓ vibrant diversified cell populations to ensure healing progression/nutrition
✓ adequate blood supply
✓ evolving scaffold for cellular differentiation
✓ mechanical environment of relative stability that minimizes fragment strain
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Remodeling phase
✓ - As the callus forms, pain should diminish significantly and with mature callus
associated swelling, pain and tenderness will diminish rapidly
✓ - Remodeling of immature trabecular bone eventually evolves into compact lamellar
bone
✓ Remodeling may continue for years but radiographic union occurs within the first
few months
Primary Fracture Healing - direct union
inflammatory phase: and time frame
POC
Regeneration Phase:
Remodeling Phase:
✓ Inflammatory Phase: surgery - day 21
✓ -Protection with intermittent AROM out of splint; RICE
✓ Regeneration Phase: 1-6 weeks
✓ -AROM, PROM and splinting can be started sooner than in the secondary healing
reparative phase
✓ Remodeling Phase: 6 weeks to 1 year
✓ -Diverse exercise program is allowed
Fracture Healing Stages Occurring with Secondary Healing
Inflammatory Phase:
Reparative Phase:
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Remodeling Phase:
✓ Inflammatory Phase: Injury to day 5
✓ * treat by protection (immobilization) protect hematoma; RICE
✓ Reparative Phase: day 5- day 21
✓ * protect fracture callus with removable splint; intermittent motion
✓ Remodeling Phase: day 21- month 18 (can go several years)
✓ * diverse exercise program
Fracture Healing Summary:
✓ Traumatic inflammation
✓ Development of a hematoma
✓ Organization
✓ Union by callus
✓ Remodeling of callus
✓ Bony union
Elements of the classification of fractures include:
✓ Location in the bone (diaphyseal, metaphyseal, etc.)
✓ Angle of the fracture (transverse, oblique, etc.)
✓ Number of fragments (simple, comminuted)
✓ Skin closed or open
Primary Elements of deformity:
✓ Shortening, Angulation and Rotation
midportion of the shaft of the bone
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FRACTURES of the UPPER
EXTREMITY Questions and Correct
Answers the Latest Update
Generally, fractures heal by _____ in children and ______ in adults
✓ 3-4 weeks
✓ 4-6 weeks
Most important factor in fracture healing is _________.
✓ blood supply
Smoking (nicotine) and systemic diseases (diabetes) have been found to
________ healing time
✓ increase
Inflammatory stage
✓ Development of hematoma and traumatic inflammation
✓ Hematoma is gradually replaced by granulation tissues around fracture ends
✓ Begins immediately after injury and last several days
✓ Swelling and hypoxia are present
✓ Inflammatory cells migrate into the area
✓ Fibroblasts, mesenchymal cells and osteoprogenitor cells present
Reparative stage-organization
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✓ Overlaps the inflammatory stage
✓ Occurs within two weeks of injury
✓ Pain usually decreases in this stage
✓ Union by callus
✓ Direct Healing (Primary Healing)
✓ Indirect Healing (Secondary Healing)
Direct Healing (Primary Healing)
✓ Occurs with rigidly immobilized fractures (i.e., plate and screws)
✓ An implant replaces external callus
✓ Primary healing does not hasten union but ensures it
✓ Union occurs by direct bone healing across the fracture site
Indirect Healing (Secondary Healing)
✓ Motion at the fracture site stimulates healing
✓ Callus formation is stimulated by motion at the fracture site
✓ Enchondral calcification occurs
✓ Fibroblasts and chondroblasts need to be present to sustain the environment long
enough for osteoblastic bone replacement
Indirect Healing (Secondary Healing)
5 factors are necessary:
✓ Hematoma
✓ vibrant diversified cell populations to ensure healing progression/nutrition
✓ adequate blood supply
✓ evolving scaffold for cellular differentiation
✓ mechanical environment of relative stability that minimizes fragment strain
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Remodeling phase
✓ - As the callus forms, pain should diminish significantly and with mature callus
associated swelling, pain and tenderness will diminish rapidly
✓ - Remodeling of immature trabecular bone eventually evolves into compact lamellar
bone
✓ Remodeling may continue for years but radiographic union occurs within the first
few months
Primary Fracture Healing - direct union
inflammatory phase: and time frame
POC
Regeneration Phase:
Remodeling Phase:
✓ Inflammatory Phase: surgery - day 21
✓ -Protection with intermittent AROM out of splint; RICE
✓ Regeneration Phase: 1-6 weeks
✓ -AROM, PROM and splinting can be started sooner than in the secondary healing
reparative phase
✓ Remodeling Phase: 6 weeks to 1 year
✓ -Diverse exercise program is allowed
Fracture Healing Stages Occurring with Secondary Healing
Inflammatory Phase:
Reparative Phase:
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Remodeling Phase:
✓ Inflammatory Phase: Injury to day 5
✓ * treat by protection (immobilization) protect hematoma; RICE
✓ Reparative Phase: day 5- day 21
✓ * protect fracture callus with removable splint; intermittent motion
✓ Remodeling Phase: day 21- month 18 (can go several years)
✓ * diverse exercise program
Fracture Healing Summary:
✓ Traumatic inflammation
✓ Development of a hematoma
✓ Organization
✓ Union by callus
✓ Remodeling of callus
✓ Bony union
Elements of the classification of fractures include:
✓ Location in the bone (diaphyseal, metaphyseal, etc.)
✓ Angle of the fracture (transverse, oblique, etc.)
✓ Number of fragments (simple, comminuted)
✓ Skin closed or open
Primary Elements of deformity:
✓ Shortening, Angulation and Rotation
midportion of the shaft of the bone
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