PATHOPHYSIOLOGY OF FRACTURE

Stress placed on a bone,

exceeds the bone ability to absorb it

Injury in the bone

Disruption in the continuity of bone

Disruption of muscle and blood vessels attached
to the ends of the bone

Soft tissue damage

Bleeding

Hematoma forms in medullary canal

Bone tissue surround the fractured site dies

Inflammatory response


When a bone is broken, the periosteum and blood vessels in the cortex,
marrow, and surrounding soft tissues are disrupted. Bleeding occurs
from the damaged ends of the bone and from the neighboring soft tissue.
A clot (hematoma) forms within the medullary canal, between the
fractured ends of the bone, and beneath the periosteum. Bone tissue
immediately adjacent to the fracture dies. This necrotic tissue along with
any debris in the fracture area stimulates an intense inflammatory
response characterized by vasodilation, exudation of plasma and
leukocytes, and infiltration by inflammatory leukocytes and mast cells.

Within 48 hours after the injury, vascular tissue invades the fracture area
from surrounding soft tissue and the marrow cavity, and blood flow to
the entire bone is increased. Bone-forming cells in the periosteum,
endosteum, and marrow are activated to produce subperiosteal procallus
along the outer surface of the shaft and over the broken ends of the bone.
Osteoblasts within the procallus synthesize collagen and matrix, which
becomes mineralized to form callus (woven bone). As the repair process
continues, remodeling occurs, during which unnecessary callus is
resorbed and trabeculae are formed along lines of stress. Except for the
liver, bone is unique among all body tissues in that it will form new
bone, not scar tissue, when it heals after a fracture."