Fracture healing, depending on the type and degree, typically
require several weeks to months for most fractures to be fully restored. There are many factors that influence the speed in which fractures heal. The reduction of fracture fragments must be accurate and maintained in order to ensure quick and proper healing.
For proper and adequate fracture healing to occur , the reduction of fracture fragments must have adequate blood supply for nourishment. It is important to consider that the type of fracture can deeply affect the time it would take for complete healing to occur. In general, fractures of flat bones (pelvis and scapula) heal rather faster than fractures affecting long bones. More so, fractures at the ends of long bones, where the bone is more vascular can heal much quicker than fracture affecting areas where the bone is more dense and less vascular such as those fractures in the bone’s shaft region. Furthermore, weight bearing stimulates healing of stabilized fractures of long bones in the lower extremities.
Effects of disrupted fracture healing
If fracture healing is disrupted, bone union may be delayed or stopped completely. Common factors that can impair fracture healing include inadequate fracture immobilization, inadequate blood supply to the fracture site or adjacent tissue, extensive space between bone fragments, the interposition of soft tissue between bone ends, infection and metabolic problems. When bones are not properly aligned during the healing process, there is a big probability that healing will take longer and there is also a high possibility of deformity in the continuity of fractured bones once healing takes place which can impede the normal range of motion of the musculoskeletal system.
Shock as a complication in fracture healing
Hypovolemic shock resulting from hemorrhage (both visible and non-visible blood loss) is one of the most common complications in fracture healing. Other causes of shock include loss of intravascular volume in the interstitial space particularly within damaged soft tissues which may occur in fractures of extremities, thorax, pelvis and spine. Since the bone is highly vascular, large quantities of blood may be lost as a result of trauma especially with fractures affecting the femur and pelvis. Treatment of shock consists of stabilizing the fracture to prevent further hemorrhage, restoring blood volume and circulation, relieving the patient’s pain, providing adequate splinting and protecting the patient from further injury and other complications.
Fat Embolism in fracture healing
After fracture of long bones or pelvic bones, multiple fractures or crush injuries occur there is a big possibility of fat embolism from developing. Fat embolism syndrome occurs most frequently in young adults (usually in those 20 to 30 years of age) and elderly adults who experience fractures of the proximal femur (hip fracture). At the time of fracture, fat globules may diffuse into the vascular compartment because the marrow pressure is greater than the capillary pressure and there is an increase in catecholamine activity as a result of the patient’s normal stress response in mobilizing fatty acids and promote the development of fat globules in the bloodstream. The fat globules, which when freely circulated in the bloodstream become an emboli that may occlude smaller blood vessels that supply the lungs, brain, kidneys, and other vital organs. The onset of this type of complication in fracture healing usually takes place within 24 to 72 hours following the injury but may also occur up to a week after injury.