The inner most layer of the long bone is the spongybone aka trabeculae

The outside is the compact bone

Outside that is the periosteum (membrane around bone) and it contains
fibroblasts and progenitor cells (osteoblasts and chondroblasts)
The bone is highly vasculised

Initially there is a haematoma/fibrin clot after the break

Then the cells in the haematoma die and are resorbed by macrophages not all
cells these include the fibroblasts (which replicates and form granulation tissue)
this occurs in hours. This is type 1 collagen
In days after the break, the progenitor cells differentiate into chondroblasts and
this makes hyline cartilage AND proximal to fracture gap. The fibroblasts also
form chondroblasts and hyaline cartilage
Distal to the fracture gap, the progenitor cells form osteoblasts and they put
down a matrix of osteoid which then converts to woven bone
The hyaline cartilage + woven bone = fracture callus. This has some strength

Osteoblasts affect woven bone and via bony substitution it gets turned into
Lamellar Bone
Via endochondral ossification, the hyline cartilage is also turned into lamellar
bone
Lamellar bone = spongy bone
The periosteum and angiogeneisis is also occurring
This usually takes 3-12weeks
Most of the strength is restored

Remodelling
Osteoclasts enter and resorbe bits of bones and the osteoblasts deposits
compact bone
Eventually, 3-5 years later, the compact bone replaced all spongy bone and the
bone is full strength

Why use casts without a cast the bone will be moving and the haematoma is
not going to work and clot/callus cant form and thus no healing of the bone.
for some need to put screws and wiring to ensure they dont move and to put the
bones closer together. Less need for earlier steps (less granulation tissue is
needed) so move straight into osteoblast formation making woven bone

Why mightnt the bone heal not together or fixed, if there is infection or
inflammation (stuff up the blood supply) leading to avascular necrosis, metabolic
bone disease (OA) leading to decrease healing, smoking, EtOH
What if the bones are not straight new bone is made on the concave side
not the convex surface.
Abnormal woven, and via piezoelectric effects (sensed by )
Increase bone formation on one side and increase absorption on the other side
Components

A fracture is a break in the structural continuity of the bone

There are several types

Based on etiology

Traumatic

Pathologic due to some disease process

Stress
Based on displacement

Undisplaced

Displaced
Translation shift
Angulation tilt
Rotation twist
Based of relationship with external environment

Simple/closed

Open
Baesd on pattern

Transverse

Oblique
Spiral
Comminuted
Segmental

There are 2 main things needed for bone healing

Blood supply
Mechanical stability
The inflammatory phase peaks within 48hrs and diminished by 1 week
Vasodilation and hyperemia
Mediation by histamines, PGs and cytokines
Neutrophils, basophils and phagocytes
Haematoma forms
Local vessels thrombose forming bony necrosis at the edges of the fracture
Increased capillary permeability results in a local inflammatory miliau
The repair phase activates in the first few days and persists for 2-3mths
4-5 days post injury
Invasion of pleuripotent mesenchymal cells
They differentatite into fibroblasts, chondroblasts and osteoblasts
Form soft primary callus contain cartilage, fibrois tissue, osteoid , woven
bone and vessels
Angiogenesis within the periosteal tissues and marrow space helps route the
cells to the fracture site and contribute to the formation of granulation tissue
bed
Healing progresses to bridging callus or hard callus formed at the periphery
of the callus by intermembranous bone formation
The remodelling phase lasts years

Direct bone healing there is no motion at the fracture site and thus no need for
callus formation. Osteoblasts originate from endothelial and perivascular
cells. Healing to be with lamellar bone immediately if direct contact between
the fracture ends; otherwise the gap (if 200-500micros) are filled with woven
bone that is remodelled into lamellar bone. If larger, healing via indirect
healing (filled with fibrous tissue that undergoes secondary ossification)
Factors that influence healing