FACTORS INFLUENCING 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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