My Orthopedic Surgery

Lecture/presentation in the Basic Fracture Course of the Orthopaedic Trauma Association

Orthoteers notes on the process of fracture healing

OTA Basic Fracture Course
Preface
Misconceptions
Fracture Healing Stages
Fracture Healing Determinants
Direct Bone Healing
* gap healing
* contact healing
* implications for plates
Indirect Bone Healing
Summary

From Aviator's Astragalus to Turf Toe

Certain regions are notorious for their propensity to develop AVN following trauma. These are
* The femoral head
* The proximal part of the scaphoid
* The lunate following dislocation
* The body of the talus after neck fracture
This page purely deals with the factors that predispose these injuries to the development of this condition.

eMedicine 2004
A fracture is defined as a disruption in the integrity of a living bone, involving injury to the bone marrow, periosteum, and adjacent soft tissues. Many types of fractures exist, such as pathologic, stress, and greenstick fractures. When a fracture occurs, it is described radiographically and clinically in terms of the following factors:
* Anatomy:
* Articular surface involvement:
* Displacement:
* Angulation:
* Rotation:
* Shortening:
* Soft-tissue involvement:
Synonyms and related keywords: fracture management, open fracture, closed fracture, broken bone, traumatic bone injury, open reduction and internal fixation, ORIF, external fixation, ankle fracture, femur fracture

Fractures have been treated with immobilization, traction, amputation, and internal fixation throughout history. Immobilization by casting, bracing, or splinting a joint above and below the fracture was used for most long bone fractures, with the exception of the femur, for which traction was the mainstay of treatment. In the past, open fractures and ballistic wounds with long bone fractures were not amenable to standard fracture care because of the associated soft tissue injury and the difficulty in preventing sepsis; thus, they usually resulted in amputation, especially during the US Civil War.
Although the concept of internal fixation dates back to the mid 1800s, Lister introduced open reduction, internal fixation (ORIF) of patella fractures in the 1860s. Use of plates, screws, and wires was first documented in the 1880s and 1890s. Early surgical fixation initially was complicated by many obstacles, such as infection, poorly conceived implants and techniques, metal allergy, and a limited understanding of the biology and mechanics of fracture healing. During the 1950s, Danis and Muller began to define the principles and techniques of internal fixation. Over the past 40 years, advancements in biological and mechanical science have led to contemporary fixation theories and techniques.
Synonyms and related keywords: broken bone, fracture, open fracture, open reduction and internal fixation, ORIF, bone screws, pretapped screws, self-tapped screws, pull-out strength, plate fixation, Kirschner wires, K-wires, Steinmann pins, dynamic compression plates, DCP, dynamic compression screw, limited-contact dynamic compression plates, LC-DCP, intramedullary nails, IM nails, biodegradable fixation, biodegradable implants
Lakatos & Herbenick 2007

by Prof. C.L. Colton, in collaboration with Prof. S. Perren
Succinct and helpful definitions of about 300 terms used in the description of orthopaedic trauma, fractures, dislocations, sprains, injuries and complications

Journal of Epidemiology and Community Health, Vol 44, 241-245 LJ Donaldson, A Cook and RG Thomson 1990
The aim was to describe the population based age and sex specific incidence of fractures at different sites in a large English health district.
The overall estimated annual incidence of fractures was 100 per 10,000 population for males and 81 per 10,000 population for females.

Timing and indcations for trauma surgery: from the OTA Basic Fracture Course

Lag Screw & Neutralization Plating: Principles & Techniques. Basic Fracture Course of Orthopaedic Trauma Association

Includes accounts of skull, chest, spine, shoulder, humerus, elbow, forearm, hand & wrist, hip & pelvis, femur knee, tib/fib, foot and ankle fractures. Also Fracture Eponyms and 'Fracture by Profession' (qv)

Comprehensive fracture and dislocation classification published by OTA in Journal of Orthopaedic Trauma Vol 10, Suppl. 1, 1996 Classification of fractures in individual bones are listed under those bones

Nonvertebral fractures (NVFs) are the most costly and disabling type of osteoporotic fractures. Bisphosphonate therapy effectively reduces the risk for NVFs; however, fracture protection depends critically on adherence and persistence. Approved bisphosphonate regimens with extended dosing intervals increase patient convenience, help patients remain on therapy, and improve fracture protection in clinical practice.
Conclusions: Extended-interval bisphosphonates offer similar or superior NVF protection with less lifestyle disruption compared with daily or weekly treatment. By removing obstacles to adherence and persistence, extended-interval oral and IV bisphosphonate regimens provide valuable therapeutic options to enhance real-world effectiveness and reduce NVF incidence.
Raymond E. Cole, DO, CCD; Steven T. Harris, MD, FACP Medscape J Med. 2009;11(1):12.

Principles of Bone Healing from Neurosurg Focus 10(4), 2001 Iain H. Kalfas, M.D., F.A.C.S. Department of Neurosurgery, Section of Spinal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio Abstract Our contemporary understanding of bone healing has evolved due to knowledge gleaned from a continuous interaction between basic laboratory investigations and clinical observations following procedures to augment healing of fractures, osseous defects, and unstable joints. The stages of bone healing parallel the early stages of bone development. The bone healing process is greatly influenced by a variety of systemic and local factors. A thorough understanding of the basic science of bone healing as well as the many factors that can affect it is critical to the management of a variety of musculoskeletal disorders. In particular, the evolving management of spinal disorders can greatly benefit from the advancement of our understanding of the principles of bone healing.