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A 12-year old patient has a bone fracture injury on his right arm with a…
A 12-year old patient has a bone fracture injury on his right arm with a broken elbow and part of the bone in the upper arm protruding from the skin. There are also fragments of bone in the wound.
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Stages of bone healing
Inflammation
A hematoma/fibrin clot immediately begins to form at site of cell death & vessel disruption. Swelling begins to occur due to inflammatory cells coming in. The inflammatory cells release enzymes and other cells such as fibroblasts and mesenchymal cells begin to get involved.
Repair
Soft callus formation
Pain and swelling subside, fibrous and cartilagenous tissue bind together the broken bone fragments. Woven bone is formed through this, creating some stability. Without stable external support (a cast, etc) the fracture can still angulate.
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Remodeling
Bone is removed in tiny increments and replaced by new bone. This can take several months or years. During this phase, medullary cavity is reconstituted.
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How bones form, grow, and remodel
Formation (also called ossification): The skeleton originates as cartilage and is gradually replaced by bone over time. Osteoblasts secrete osteoid, which is a matrix material. After the osteoid is laid down, inorganic salts are deposited to harden into mineralized bone. Cartilage cells die and are replaced by osteoblasts.
Growth: Chondrocytes in region of the epiphyseal continue to grow by mitosis and when they die, are replaced by osteoblasts. This process repeats until cartilage development stops.
Remodeling: Mineralized bone is removed by osteoclasts and bone matrix is formed again through osteoblasts that eventually become mineralized
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