FACTORS INFLUENCING FRACTURE HEALING - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE - Orthodnb.com

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE - Orthodnb.com

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Saturday, 30 June 2018

FACTORS INFLUENCING FRACTURE HEALING

FACTORS INFLUENCING FRACTURE HEALING




Image result for fracture healing
Systemic factors
  • age
  • activity level
    • general immobilization
    • space flight
  • nutritional status
  • hormonal status
    • growth hormone
    • corticosteroids (microvascular osteonecrosis)
    • others (thyroid, estrogen, androgen, PTH, PG)
  • diseases
    • DM, anemia, neuropathies
  • Vitamin deficiencies – A,C,D,K
  • Drugs – NSAIDS, Anticoagulants, Ca channel blockers, Cytotoxins, Bisphosphonates, Phenytoin, NaF
  • Other substances – Nicotine, Alcohol
  • Hypoxia
  • Systemic growth factors
  • Environmental factors
  • CNS trauma
Local factors
  • factors independent of injury, treatment or complications
    • type of bone – cortical or cancellous
    • abnormal bone
      • radiation necrosis
      • infection
      • tumors
    • denervation
  • factors dependent on injury
    • degree of local damage – compound #, comminuted #, velocity of injury
    • disruption of vascular supply of bone, fragments, soft tissue
    • type and location of #
    • loss of bone
    • soft tissue interposition
    • local growth factors
  • factors dependent on treatment
    • extent of surgical trauma – blood supply , heat
    • implant induced altered blood flow
    • degree and kind of rigidity of internal or external fixation and influence of timing
    • degree and duration of load induced deformation of bone and soft tissue
    • extent of contact between fragments (gap, displacement and distraction)
    • factors stimulating post traumatic osteogenesis ( bone graft, BMP, electrical stimulation)
  • factors dependent on complications
    • infection
    • venous stasis
    • metal allergy

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