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What are the necessary conditions for appropriate bone healing

What are the necessary conditions for appropriate bone healing (leading to minimal functional residuals) and how may physicians optimize the chances for healing? 

 

Successful bone healing requires:

  • adequate blood supply, 
  • relative mechanical stability,
  • sterility and 
  • intact surrounding soft tissue.

 

 

Here is a talus that died because of inadequate blood supply

 

Here is a fracture that did not heal because it was not held rigid

 

Nonunion.jpg

 

Here is a fracture that did not heal because it got infected (pins are from an external fixator)

 

Pseudoartrosi settica di tibia

 

Here is a fracture that is going to have a tough time healing due to a dearth of intact surrounding soft tissue.

 

 

 

Physicians may optimize chances of healing by promoting the proper mechanical and biological environment.
Specific measures include:

  • Reducing (aligning) the fracture;
  • making sure the blood supply and soft tissue envelope are preserved or restored
  • preventing or treating infection;
  • minimizing edema (more for pain control and compartment syndrome prevention, but also to promote perfusion) and
  • allowing just enough loading on the bone to stimulate bone growth but not so much to ruin the reduction or prevent hardening of the fracture callus. (gross motion at the fracture will lead to a so-called fibrous union: some tissue there, but not hard tissue)

 

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