basic science

Fracture Healing Biology

intermediate

6 min

28 marks

6 questions

Clinical Scenario

A 35-year-old male presents 4 months after closed treatment of a midshaft tibial fracture. Radiographs show persistent fracture lines with minimal callus formation. He has pain with weight-bearing and tenderness at the fracture site. He has been non-weight-bearing and is a smoker (20 pack-years).

Radiographs at 4 months are provided.

Open Full Size

Clinical image for Fracture Healing Biology

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the stages of fracture healing. What is the difference between primary and secondary bone healing?

Question 2 (5 marks)

What factors influence fracture healing? Classify them into local and systemic factors.

Question 3 (6 marks)

Define delayed union and nonunion. What are the types of nonunion and their radiographic characteristics?

Question 4 (5 marks)

Describe the biological and mechanical factors that determine the type of healing. What is the role of strain in fracture healing?

Question 5 (4 marks)

What interventions can enhance fracture healing? Describe the evidence for each.

Question 6 (4 marks)

How would you manage this patient's delayed union?