Fractures – causes and types

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Phases of fracture fusion

After a fracture, the damaged bones of most people fuse in a chondroblastic type. Chondroblasts are the youngest and active cells of the cartilaginous tissue. They have an oblate shape, are located inside the perichondrium and along the entire thickness of the cartilaginous tissue. At the stage of growth and fusion of bones in the chondroblasts, the process of mitotic division and fermentation takes place. In other words, the person is obliged to the chondroblasts to the growth of the skeleton and its recovery after traumas.

The cartilage bone callus is formed at the site of the fracture. This process lasts several months, and includes four main phases.

The first phase is catabolic (7-10 days):

  • In the surrounding fracture site, soft tissues develop aseptic (ie, without the participation of microbes) inflammation.

  • Extensive hemorrhages occur.

  • Circulation in tissues around a fracture is broken as a result of stagnation of blood.

  • Toxic products of aseptic inflammation are thrown into the bloodstream and spread throughout the body, which explains the overall poor state of health (increase in temperature, weakness, chills, nausea).

  • Enzymatic cellular activity increases around the fracture site.

  • On the surface fracture of bones necrotic processes occur (microscopic ulceration and withering sites appear).

  • There is no evidence of fusion of broken bones.

h3 The second phase is differential (7-14 days):

  • The process of formation of fibrous-cartilaginous callus is started (new cells are actively produced at the fracture site: chondroblasts, fibroblast Chondroitin sulfate is a substance whose carbohydrate chains are 90% identical to monosaccharides galactosamine and glucosamine.

  • Gradually the basis of the future callus is formed – metric. In the cells around the site of the fracture, collagen fibers are actively produced. At this stage, the callus is still fibro-cartilaginous, that is, there are no channels of blood supply vessels in it. It feeds on fluid from the extravascular space, which is almost ten times larger than in the intravascular space. Due to this difference, the osmosis process takes place – one-way diffusion of fluid through the cell membranes towards a higher concentration. The third phase is primary-accumulative (2-6 weeks):

    • Small capillaries that form a vascular network of the future bone callus gradually grow from the surrounding tissues into the fibrous-cartilaginous corn. The molecules of chondroitin sulfate located in mitochondria of cartilaginous cells, are combined with ions of phosphates and calcium.

    • The regulatory enzyme citrate synthetase and g The main energy carrier in cells – adenosine triphosphate (ATP) helps active synthesis of calcium phosphate. Chondroitin sulfate molecules then combine with calcium phosphate, enter the extracellular space, and already there react with collagen. In this period, the concentration of silicon and magnesium ions also greatly increases in the cartilaginous tissue. With the participation of these elements from calcium phosphate and collagen at the site of the fracture, a primary callus is formed. While it is still very poorly mineralized, it has no ordered crystalline structure and therefore is not strong enough. The fourth phase is mineralization (2-4 months):

      • A molecular complex of chondroitin sulfate and calcium collagen pyrophosphate is formed in the extracellular space of the primary bone callus. These molecules react with phospholipids, resulting in crystalline hydroxyapatite.

      • The crystals of hydroxyapatite, in turn, settle around the collar fibers in a special way – so that their axes are located at an angle of 41 degrees relative to each other.

      • From this tandem, the first nuclei of crystallization of the callus are obtained. Moreover, they can increase in size, feeding on inorganic ions from the fluid surrounding the soft tissues. This process is called the primary mineralization of the bone.

      • Then secondary mineralization occurs – intercrystalline bonds around the nuclei are formed. At the end of this stage, one can speak of the complete completion of the fracture fusion.

      The features of the phase flow

      The averaged data on the course of the flow and duration of each phase of bone fusion. Calculations are made, proceeding from the fact that before us is a relatively healthy patient, and the trauma is not characterized by an increased complexity.

      But the fractures are different, and the rate of recovery directly depends on many factors:

      • . Type of fracture (open or closed, multiple or single, on one bone or on The age of the patient (in older people the fusion of bones can last more than six months, and in adolescents it can end in a month).

      • The general state of health (bone mineralization, blood quality, muscle tone).

      • The presence or absence of aggravating factors (concomitant diseases and injuries) – the more damage to the bones, organs and soft tissues the patient received as a result of the injury, the longer the rehabilitation process will continue. / h
        h2 Treatment

        a closed fracture of the patient is soothed by an anesthetic that pushes into the fracture site. The broken place is strengthened, for example, by a tire, so that the bone and its broken honor are in a fixed position. If the fracture is of an open type, then the pain is also relieved and the victim is brought to his senses, but only in such a way that he is in an adequate state, then the bleeding should be stopped by holding the wounds. The bone is also fixed in the tire and in the immediate order of the victim is delivered to the hospital. If the bleeding does not stop, and this occurs with arterial or venous damage, then a tourniquet is superimposed above the affected area.

        Upon arrival, the patient will be given bone, but this will only happen under full anesthesia or, for example, anesthesia. If the fracture is not seen enough, the skin is cut a little. Bone is fixed with gypsum.

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