I HAVE TO REPLY TO 2 POSTS
FIRST REPLY
In my past experiences, I have observed a complete fracture on my nephew as he is a 17-year-old football player in high school and had a sports injury on his tibia bone and it seemed to be a spiral fracture, the signs, and symptoms he showed were bone stiffness, restricted range of motion, and swelling as well as redness, tenderness, and pain. Due to the type of fracture physical therapy was completed in order for him to recover and the stages of bone healing were completed.
The following is the bone healing process that took place Hematoma formation, the force that breaks the bone will also rupture blood vessels. This results in hematoma formation (Clot formation). This takes place for a few hours and days Granulation tissue formation, after few hours or few days, the cell such as macrophages, monocytes, lymphocytes, and polymorphonuclear cells will infiltrate the bones. This will make the formation of granular tissue, in the growth of vascular tissue and migration of mesenchymal cells. Callus formation As the vascular ingrowth progressing the collagen matrix is laid down on the injury along with osteoid secretion and mineralization. This results in the formation of a soft callus around the injury. This takes place for 4-6 weeks of the healing process. Consolidation a woven bone is laid down on the callus but after it is replaced by lamellar bone. This process can take months. Remodeling the healed lamellar bone aligns themselves in the direction of the forces acting on them and the remaining bits of bones are reabsorbed. His healing process took place within 8-10 weeks with proper rehab and nutrition due to him not having any factors that impaired his healing process.
Closed fractures can be simple (a clean break with little damage to the surrounding tissue) or open (a break in which the bone pierces the skin with little damage to the surrounding tissue). Most open fractures are emergencies. One that breaks the skin is especially dangerous because there is a high risk of infection. (Zaki 2020)
Bone-building cells called osteoblasts contribute mineral that changes to bone, and the new bone fills in the break, strengthening with time. Nicotine from cigarettes interferes with this process, causing smokers’ bones to take longer to heal
Cigarette smoking has a negative impact on the skeletal system, causes a decrease in bone mass in both young and old patients, and is considered a risk factor for the development of osteoporosis. In addition, it disturbs the bone healing process and prolongs the healing time after fractures. The mechanisms by which cigarette smoking impairs fracture healing are not fully understood. (Chang 2020)
References
Chang, C. J., Jou, I. M., Wu, T. T., Su, F. C., & Tai, T. W. (2020). Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union. Bone & joint research, 9(3), 99–107. https://doi.org/10.1302/2046-3758.93.BJR-2019-0089… (Links to an external site.)
Zaki, P., Khakimov, S., Hess, J., & Hennrikus, W. (2020). Femur, Tibia, and Fibula Fractures Secondary to Youth Soccer: A Descriptive Study and Review of the Literature. Cureus, 12(5), e8185. https://doi.org/10.7759/cureus.8185
SECOND POST
In my past clinical experience, I witnessed multiple injuries in which resulted in various bone fractures. However, one experience that I vividly remember was that of a 19-year-old male who suffered an open-shaft fracture (compound fracture) of the tibia during a motorcycle accident. Per Elniel and Giannoudis (2018), open fractures of the tibia are the most common open long bone fractures. On examination, the open fracture was accompanied by extensive soft tissue loss and bone damage. After radiographs were completed, it showed a complex multi-segmented displaced tibia fracture. With such severity, the patient showed signs and symptoms of localized pain of the affected leg, visible areas of swelling, inability to bear weight, bruising, changes in sensation, and bleeding upon arrival (Pizzolo et al., 2018). Treatment included stabilization with external fixation, debridement, irrigation, and antibiotic therapy. Due to the severity of the injury, healing took 16 weeks with continuous physical therapy being performed.
The stages of bone healing are as follows:
(1) Hematoma formation begins immediately following a fracture and the hematoma clots and forms the temporary frame for subsequent healing, (2) fibrocartilaginous callus formation in which chondrogenesis begins to occur, laying down a collagen-rich fibrocartilaginous network, (3) hard, calcified callus of immature bone forms, (4) replacement, and (5) remodeling, resorption by osteoclasts and new bone formation by osteoblasts (McCance, 2019). The bone healing process can take months to years to see significant changes and this timeframe is dependent on numerous of factors (Karpouzos et al., 2017).
For example, smoking is one factor that impairs the process of bone healing. According to Chang et al. (2020), studies have shown that “cigarette smoke alters fibroblast migration and survival, which is essential for callus formation, contains inhibitors of chondrogenesis and inhibits osteogenic differentiation and proliferation of human osteoprogenitor cells.” These studies all affect stages in bone healing process. Smoking not only affects the healing process however also primarily places individuals at risk for fractures to begin with. Individuals suffering from fractures who are smokers, must be educated on the importance of stopping for appropriate healing to occur. Other factors such as proper nutrition play a crucial role in successful bone healing.
References
Chang, C. J., Jou, I. M., Wu, T. T., Su, F. C., & Tai, T. W. (2020). Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union. Bone & Joint Research, 9(3), 99–107. https://doi.org/10.1302/2046-3758.93.bjr-2019-0089…
Elniel, A. R., & Giannoudis, P. V. (2018). Open fractures of the lower extremity. EFORT Open Reviews, 3(5), 316–325. https://doi.org/10.1302/2058-5241.3.170072
Karpouzos, A., Diamantis, E., Farmaki, P., Savvanis, S., & Troupis, T. (2017). Nutritional Aspects of Bone Health and Fracture Healing. Journal of Osteoporosis, 2017, 1–10. https://doi.org/10.1155/2017/4218472
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby Elsevier.
Pizzolo, S., Testa, G., Papotto, G., Mobilia, G., di Stefano, G., Sessa, G., & Pavone, V. (2018). Open tibial fracture in a non-compliant patient. Journal of Functional Morphology and Kinesiology, 3(3), 44. https://doi.org/10.3390/jfmk3030044
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