An 18-year-old was admitted to the emergency room after being injured in a footb

Question

An 18-year-old was admitted to the emergency room after being injured in a football game. He had fallen on his left wrist and when admitted was noted to have an open fracture of the wrist. He was admitted to the hospital for surgical repair of the fracture. The x-ray showed his wrist bone was in three parts and a small part was extending through the skin.

1. What factors could impair bone healing in this patient?

2. Describe the four steps of fracture healing.

3. What are the risk factors that increase this patient’s chance for osteomyelitis?

Explanation / Answer

1. ANS: Factors affecting fracture healing:

A. Blood Supply: Soft tissue injury, Radiation, Chemical or thermal burns, Infection, Anaemia & hypoxia, Denervation, Excessive compression (more than 30lbs) and Age.

B. Excessive Movement: Inadequate immobilisation and inadequate fixation or compliance

C. Gap: Interposed soft tissue, intact fellow bone and distraction of bones.

D. Other: Nutrition (Vit C required for normal collagen) and Drugs (corticosteriods inhibit osteoblast differentiation.

2. ANS: Four steps of fracture healing:

Step 1: A hematoma (blood clot) forms from the ruptured blood vessels of the periosteum and bone. Bone cells deprived of nutrition die. Tissue becomes swollen, painful and inflamed.

Step 2: In this spongy bone forms close to developing blood vessels and the fibrocartilage forms in more distant regions. The fibers and cartilage are deposited throughout the clot by fibroblasts forming a cartilage callus. Then the cartilage callus bulges over the side of the bone in the form of a splint to keep the ends together.

Step 3: The cartilage callus is converted to woven bone, and is now called a bony callus. In this the bony callus replaces cartilage.

Step 4: The woven bone is remodelled to resemble the original bone, with compact on the outside. The osteoclasts remove excess bony tissue restoring new bone structure to original form.

3. ANS: Osteomyelitis is a bone infection that generally caused by bacteria. In most of the cases it is caused by staphylococcus aureus bacteria, which are most predominantly found on our skin and nose.

Risk factors for osteomyelitis:

A. Long term skin infections.

B. Inadequately controlled diabetes.

C. Circulation disorders: When blood vessels are damaged or blocked Ex: arteriosclerosis.

D. Problems requiring intravenous lines or catheters. Ex: Dialysis machine tubing and Urinary catheters.

E. Conditions that impair the immune system. Ex: Chemotherapy and Poorly controlled diabetes

F. Illicit drugs

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