Book reading

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Book reading
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Injury variable

• Open fracture
• Soft tissue disruption
• soft tissue cover
• Bone loss
• Fracture displacement
• Infected union

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Injury variable

• Severity of injury
• Comminution
• Displacement
• Intra-articular fracture
• Alignment
• Joint Congruity
• Joint stiffness
• Soft tissue devitalization vs surgical Exposure
• Failure most in proximal and distal tibia and
  distal radius

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Injury variable

• Segmental fracutre
• Impair intramedullary blood supply.
• Distal tibia vs Femur
• Middle segment
• Soft tissue interposition
• Closed reduction failure
• Damage to blood supply
• Femoral head, scaphoid,talar
• Surgical exposure

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Patient variable

• Age
• Pediatric vs Adult
• Increasing age equal to decrease healing rate
• Nutrition
• Long hospital stay
• Less likely to prefracture status
• Infection
• Wound dehiscence

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• Systemic hormones
• steroid inhibit osteoblast differentiation blood
  supply.
• Decrease synthesis matrix
• Decrease bone quality
• Nicotine
• Smoking inhibit bone healing

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Tissue variables

• Cancellous or cortical
• Bone necrosis avascular zone, radiation,
  steroid.
• Bone disease Tumor, infection. Metabolic disease
• Osteoporosis
• Impair fracture healing???
• Decrease bone massgt more time to restore bone
  mass
• Prone to failure of internal fixators.

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Treatment variables

• Apposition of fracture fragments
• Loading and micromotion
• Fracture stabilization

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Synovial joint healing

• Cartilage lack of blood supply
• Healing process like bone healing
• Differentiate to cartilage
• Two categories
• Disruption of soft tissue
• Direct mechanical injury

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• Healing following disruption of soft tissue
• Alter cartilage matrix composion
• Decrease synthesis proteoglycan?Decrease
  cartilage stiffness
• Duration???
• Keep surface moist with physiologic solution

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• Healing following damage to articular surface
• Blunt trauma without tissue disruption
• Trauma that disrupts cartilage
• Limited to articular cartilage
• Osteochondral injury

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• Blunt trauma without tissue disruption

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• Injury limited to articular cartilage

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• Osteochondral injury