Factors Influencing Fracture Healing

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I. Systemic Factors    

1. Age

2. Activity level including    
  • General immobilization
  • Space flight  
3. Nutritional status

4. Hormonal factors    
  • Growth hormone
  • Corticosteroids (microvascular osteonecrosis)
  • Others (thyroid, estrogen, androgen, calcitonin, PTH, prostaglandins)
5. Diseases: DM, anemia, neuropathies, tabes

6. Vitamin deficiencies: A, C, D, K

7. Drugs: nonsteroidal antiinflammatory drugs (NSAIDs), anticoagulants, factor XIII, calcium channel blockers (verapamil), cytotoxins, diphosphonates, phenytoin (Dilantin), sodium fluoride, tetracycline

8. Other substances (nicotine, alcohol)

9. Hyperoxia

10. Systemic growth factors

11. Environmental temperature

12. Central nervous system trauma


II. Local Factors    

A. Factors independent of injury, treatment, or complications    
1. Type of bone

2. Abnormal bone    
  • Radiation necrosis
  • Infection
  • Tumors & other pathological condns
3. Denervation
B. Factors depending on injury    
1. Degree of local damage    
  • Compound fracture
  • Comminution of fracture
  • Velocity of injury
  • Low circulatory levels of vitamin K1 
2. Extent of disruption of vascular supply to bone, its fragments (macrovascular osteonecrosis), or soft tissues; severity of injury

3. Type and location of fracture (one or two bones, e.g., tibia and fibula or tibia alone)

4. Loss of bone

5. Soft-tissue interposition

6. Local growth factors
C. Factors depending on treatment    
  1. Extent of surgical trauma (blood supply, heat)
  2. Implant-induced altered blood flow
  3. Degree and kind of rigidity of internal or external fixation and the influence of timing
  4. Degree, duration, and direction of load-induced deformation of bone and soft tissues
  5. Extent of contact between fragments (gap, displacement, overdistraction)
  6. Factors stimulating posttraumatic osteogenesis (bone grafts, bone morphogenetic protein, electrical stimulation, surgical technique, intermittent venous stasis [Bier])
D. Factors associated with complications    

  1. Infection
  2. Venous stasis
  3. Metal allergy 

Comments

  1. Unknown13 October 2016 at 13:19

    Very systematically written. Lot of help for exam goers :)

    ReplyDelete

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