Can heal two broken people together
Fracture healing disorders
How does a fracture heal and what is a fracture healing disorder? A broken bone, or what medical professionals call it, can heal in two different ways. In primary or endosteal fracture healing, the bone fragments grow together primarily from inside the bone.
Bone-forming cells, the so-called osteoblasts, directly bridge the fracture gap. This type of fracture healing is primarily observed after surgically treated bone fractures, because for this the bone fragments have to be brought back into the correct position as far as possible and have to be pressed against each other in an absolutely stable manner at the edges of the fracture.
If there is little relative mobility of the fragments to one another or if defects arise between the fragments due to the fracture, secondary fracture healing usually occurs. Their characteristic is the so-called callus formation, which takes place in several stages. First, a hematoma (bruise) forms between the ends of the fracture, then the bone fracture is grown around and connected by connective tissue. This soft callus is then first converted into braided bone and, in the last step, into lamellar bone.
In contrast to other tissues, which usually heal as scar tissue of poor quality, the bone is able to regenerate completely. Regardless of primary or secondary fracture healing, the end of the healing process is the restoration of the complete integrity and stability of the bone. How long this takes depends, among other things, on which bone is affected. The metacarpal or forearm bones normally take four to six weeks to complete, whereas the shin bone takes ten to twelve weeks.
This process is impaired in the case of a fracture healing disorder. Delayed fracture healing is used when a fracture does not show any signs of bone healing within the normal healing time, which is dependent on the affected bone, as mentioned above. If the fracture does not heal for more than six months, it is by definition a so-called pseudarthrosis. However, the individual circumstances must be taken into account in the weekly and monthly figures, which are used as guide values. For example, children's bones generally heal faster than old people's.
++ More on the topic: Causes of a fracture healing disorder ++
How is a fracture healing disorder expressed and how is it diagnosed?
The main symptom of a fracture healing disorder is pain in the area of the fracture. They are caused by the sustained movement of the bone fragments, which can sometimes lead to audible noises called crepitations. In addition, patients often say that the affected bone feels unstable. These symptoms give the doctor the first clues about the disease. This is followed by a physical examination with a focus on the fracture area.
The most important diagnostic tool to substantiate the suspicion is the X-ray examination. The images make a bone fracture healing disorder or a pseudarthrosis recognizable by means of visible features, such as an open fracture gap or the so-called sclerosis border around the fragments.
The definitive confirmation is then given by a computed tomography. With this imaging method, even small defects in the bone tissue can be made visible, the extent of the bone healing disorder and even conclusions drawn about possible causes.
The latter is one reason why a detailed discussion between doctor and patient is always part of the diagnosis. This clarifies whether there are unfavorable factors such as diabetes. In some cases, additional examinations such as magnetic resonance imaging or bone scintigraphy are necessary.
How is a fracture healing disorder treated?
The therapeutic strategy is to create the best possible conditions for fracture healing. Surgical intervention is usually unavoidable in order to create the necessary mechanical and biological conditions in the affected patient. First of all, if any, infected or dead bone and soft tissue are removed. In the next step, the doctors stabilize the fragments with the help of suitable osteosynthesis material, i.e. plates, screws and nails. Sometimes an “external fixator” is used for this, which holds the bone parts from the outside and presses them together.
++ More on the topic: Treatment of a fracture healing disorder ++
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Univ.-Prof. Dr. Gerold Holzer
Silvia Hecher, Mag. (FH), MSc
Kwasny O, Dannhäuser F: Pseudarthroses - classification, causes, therapy concepts;
Müller M: Surgery for study and practice 2010/11. Medical Publishing and Information Services, 10th Edition, 2010
Peichl P, Holzer LA, Maier R, Holzer G: Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg on 2011; 93: 1583-7
Wülker N: Pocket textbook for orthopedics and trauma surgery. Thieme Verlag, 2nd edition, 2010
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