Fracture Healing - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's animated educational video describing fracture healing.
The stability of the fracture decides what type of healing will occur. If there is a small amount of strain (below 2%), the primary bone healing will occur. The primary bone healing will occur like when you are using a compression plate. If the strain is between 2-10%, then secondary bone healing will occur such as when using a cast, rod or external fixator. In primary bone healing, you will need absolute stability, called Haversian remodeling cutting cone remodeling, or sometimes called intramembranous healing.
Secondary bone healing will occur when the fixation is not rigid, such as with a cast, and there will be endochondral ossification. With an IM rod, there will be secondary bone healing, early on, there will be periosteal callus. Later on, there will be a medullary callus.
The external fixator is predominantly periosteal callus with endochondral ossification, because most of the time the external fixator is not very rigid. When endochondral ossification fails, because the fixation is inadequate, you get hypertrophic nonunion and you will have predominantly type II collagen. The endochondral ossification at this point has failed and stability is needed in order to change the cartilage to bone.
What are the stages of fracture healing?
1-Hematoma
2-Inflammation
3-Soft callus
4-Hard callus
5-Remodeling
When the fracture occurs, there will be bleeding at the fracture site. It will make a fibrin blood clot.
1-Stage of inflammation
Cells
•Macrophages
•Mesenchymal cells
•Stem cells migrate to the fracture and form the granulation tissue and will release the growth factors. Granulation tissue tolerates the greatest strain before failure.
COX-2 inhibitor and nonsteroidal depresses Runx2. Important for the differentiation of osteoblasts.
2-Stage of soft callus
•Will occur within two weeks.
•The amount of callus correlates with the immobilization.
•The stiffer the immobilization, the less amount of callus.
•Flexible fixation will result in endochondral ossification (abundant callus).
•Secondary bone healing: healing through cartilage formation. The stability helps direct bone formation. Lack of stability helps the formation of cartilage, which later on can change to endochondral ossification.
3-Stage of hard callus
•The collagen changes from predominantly type II, to be followed by type I.
•Type I= bone
•Type II =cartilage
4-Stage of remodeling
•The stage of remodeling will begin at 2 weeks and continue many years after the fracture has healed.
•The woven bone will be replaced by stronger, laminar bone and the fracture healing will be complete with the continuation of the medullary cavity.
•The remodeling of the bone is influenced by the Wolff’s law (means that the bone is affected by stress).
You need to be aware of this order of bone healing because sometimes it comes on the exam.
Blood flow at the fracture site is very important for fracture healing. The blood will supply the fracture with nutrients and cells. Initially there Is decreased blood flow at the fracture site which will increase later on and the blood flow will peak at two weeks and return to normal after about three months.
Distraction osteogenesis
Can get type I and type II cartilage (predominantly type I) because there is more intramembranous ossification.
How does the endochondral bone formation occur?
•Chondrocyte proliferation then hypertrophy
•Matrix mineralization
•The chondrocytes die
•Vascular invasion, ossification, and remodeling to lamellar bone.
What are the growth factors involved in fracture healing?
Bone morphogenic protein: osteoinductive causing the undifferentiated mesenchymal cells to differentiate into osteoblasts.
Transforming growth factor beta (TGF-B1): will make the mesenchymal cells produce type II collagen and proteoglycans (trying to produce endochondral ossification)
Insulin-like growth factor 2 (IGF-2): will stimulate type I collagen
Platelet derived growth factor (PDGF): will be released from the platelets. Attracts inflammatory cells to the fracture site (chemotactic).
Follow me on twitter:
#!/DrEbraheim_UTMC
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
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[@qfourr]

Come here with a broken foot and left ready for the exam

[@blackbartsimps0n560]

Hahahah I’m here w a broken ankle funniest comment I’ve seen all day 😂

[@Disk-Etiquette]

@@blackbartsimps0n560 ayy I'm also with a broken ankle

[@EssexTed]

Broken arm 😃👍

[@diablo5059]

Broken tibia

[@EssexTed]

For any one else with a broken arm as I was 18 days ago... I had a plate put in 2 weeks ago and im now pretty much fully functional ... Amazing! Much better than the ankle I broke last year 😜

[@GodfreyTempleton]

I had bone lengthening on my femur following a previous mal union of a fracture. It was frightening, but believe in your bones to fix themselves, it will come good, it did for me.

[@samasbeck6570]

Glad you had a good recovery!

[@saludvitalvertebralluisehe4777]

I use your videos with my patients, Great material, thanks for shear your knowledge and values.

[@mohammedholba2498]

Thank you very much for such a good educational video.

[@shahbazkhan-br3fj]

thank you, the video was very informative and helpful ……… plz make more of such videos on other topics as well

[@Serika17]

Types of collagen: Type 1 : bOne Type 2: Car2lage Type 3: re3cular fibers Type 4: 4 on the floor (found in the basement membrane)

[@mohamedrashid5517]

That's helpful ☺️

[@brittalbach416]

thank you so much, Dr. Ebraheim, this video was very helpful to me, very well explained God bess you and keep up your great work

[@abossomss496]

Excellent review 😍😍 Thank you doctor

[@chesonikevin7172]

straight to the point.

[@user-ke2kx4fr6f]

Very helpful to my presentation on fracture healing. It's really educational, so thank you very much.

[@vloggingwithconnie1635]

Great explanation.

[@motocephalic]

good review , thanks

[@Liloldliz]

this presenters voice is incredible 💜

[@michellelucky94]

Thank you dr very useful information

[@baraaamer9869]

الله يكرمك بعلمك الواسع....

[@VijayKumar-yp5mh]

Nice information, thx

[@joannecampbell3666]

Well, I know that the body is an amazing thing. I was one of very few who decided not to have surgery on my hip fracture. I’m amazed, at how after nearly one month I can almost walk normally indoors. I will use crutches outside for the 6 weeks recommended (another three weeeks or so), but x-rays show I’ve been healing well..I’ve not exactly lead a healthy lifestyle, but this has really made me think how prescious our bodies are, and I took my health for granted the rreason for this fracture and both my wrists in April was abuse of strong sedatives). I know the pain was worst during the inflammation stage, but after a week I was better. I’d get flare ups, but now I feel no pain at all and have good movement. I know in these last three weeks I’ve been pretty dumb and pushing my body to limits - travelling, and too much weight bearing etc.. I’m just very thankful I did no damage. I had times of horrific anxiety about never being able to walk properly or dance again. I know that in just one week I shouldn’t have travelled, and it was pretty humiliating to have to travel as a disabled person, sit in a wheelchair and be ported by lift into the aircraft. But I just kept my head up and smiled..... *Positive thinking*. ❤️ I’m just thankful for having the strength in me to somehow get through this tough time. I would have hated to have had to go through more surgery, as I’ve already had a back operation as a kid, and two wrist fractures 7 months ago, which were secured with metal pins and plates. I had no say at the time, it was very rushed, and I was barely conscious. The surgeon just decided they needed operating. This time I know I took a big risk, because apart from the spinal cord or pelvis, the hip is the most serious fracture. Although it was considered an ‘unstable feacture’, it seems to have healed very well (not without initial intense pain and mobility issues). I had what they call a ‘femoral stress’ or ‘hairline’ fracture. Yeah....nature is an amazing thing. I just can’t wait to be fully mobile, because if you love music, and also ballet, this sort of thing can be absolutely devastating. I was terrified I’d never heal. When I signed that disclaimer form in hospital, I knew I was gonna be out there - me, the big world, and my mangled body. But nature truly has been goood to me; I often don’t think I deserve it, for the way I treat my body... I thank God every day for forgiving me for not looking after my body (and, like, racing round shops with a shopping cart, holding onto it with my weight, in heels, with my crutches in the cart, just a few days after I fell). I could make a comedy of the stares I got from people... well at least I’m being good now, and wearing hospital socks and compression stockings, lol. Think I’ve gottwn into my typical essay mode. It’s just been such a worrying time, but as I say, nature is amazing. But I know not to take it for granted. That was my lesson... Thanks for the info. X

[@FirstnameLastname-dm2xl]

Let it out lol, it's good that you're ok now.

[@craigdcosta7314]

That's amazing! But yeah like you said, our bodies are pretty fragile so make sure you're doing the most to take care of it. Hope 1 year on your hip is fully healed and youre back up and dancing!

[@bogdankendziora5172]

I asked about a non surgical outcome and was told bad idea. If I had to decide again I would opt out of surgery. The pins don't increase strength. That's MY opinion. Thnx, B

[@Hugex97]

Exactly the same. 0 breakfast, fast food, smoking and drinking person here. I broke my femur "head" 2 weeks ago and I quit smoking, and all the unhealthy lifestyle from.before. We gotta take care of our bodies, in a second fragment, you can lose something so precious as normally walking

[@mrintrovert139]

Sis, u are very brave.... yesterday my biceps bone break into two pieces....doctor said i have to put stainless steel rod to join that area Guys i am in very depression right now

[@karendamaris5929]

It's a nice presentation

[@steveflor9942]

Hope my rt. Collar bone remembers how to do that stuff. It's been 18 days since I broke it - bicycle accident.... It' s nearly 70yrs old!!

[@neelamshahzadi3095]

Informative video

[@itssomeone4407]

Thanks

[@shamakuma1967]

What factors are taken into consideration while an implant is removed or retained within the bone.

[@shamakuma1967]

If you pass an IM nail and it causes an intramedullary callus will this callus affect hematopoesis and blood flow.

[@sitinazliayazid874]

“The stiffer the immobilization, the kess amount of callus” what does this mean?? Is it due to immobilisation that caused poor blood flow?

[@emmanuelk5653]

Excuse pls i had a break at my shin area through the healing i have this hard bone poped out on my leg n it has bent my leg little bit, will it become normal? Thank u

[@shado-ops1533]

After a year and few months… once I’m fully healed. Does it take a lot more force to break my arm again? Or does it take less?

[@timbatec]

Hello Mr. Nabil, recently I have broken my knee cap (non displaced), I have watched all your videos regarding patella fractures and bone fracture, extremely informational videos! I need advice, I am very active sport male in mid 30s, I want to be back with sports asap, I am considering HGH (Somatropin) to increase bone growth and healing .. I need your opinion! Thanks in advance and keep on with your good work!

[@FRANCJ02]

How many weeks does it take from one stage to the next ?

[@lalchhanhimihmar7541]

Good

[@liammulligan1279]

Thats great .i have a break on my fibula .its about 3" below my knee . It happened almost weeks ago . Im wearing a boot however im not sure how much the boot helps with stabilisation. The bone has not knitted yet. Is this ok ?

[@sayratuazon2352]

Ther is a possibility to heal my bone in my left leg if ther is stainlessness steel implant? Thanks for the answer

[@RaaTkRahi]

I have a proximal tibia schadzker 04 fracture and distal femur medial condyle , i am recovering from 4 months, pls give some tips for exercise, my knee is not bending

[@kalyanadithya4993]

How many months are bone remodaling time period

[@na7525]

Can you please explain for me the deformities of the wrist, hands and fingers seen in rheumatoid arthritis ?!

[@Liloldliz]

Hi, I know it has been a while, but in RA the immune system attacks first the synovial membrane then the surrounding tissues. So the inflammation occurs at the joints, and starts to destroy the synovium, cartilage and even bone. The deformation or "flail joint" develops after the inflammatory stage, during the proliferation stage of healing. It's similar to the skin healing process where we see a progression of injury-> inflammation -> proliferation -> granulation stages.

[@adengappa3363]

Any videos for nonunion

[@VinodKumar-vj4qm]

How many days teaking remodeling boans

[@lindaguida4074]

Broke tibia, hairline fracture on femur, wearing brace, PT soon!

[@joannaaligsao1089]

My husband has a non union tibia fracture. Its 6 months now since the fracture bone occur.. What is the best we can do?

[@iamshintaro]

Go for surgery mam

[@kevingichu7072]

sweet

[@rasila88]

I am not a student, I fractured femor head. This interesting I had inflamation which passed, It is about 6 weekd ago and flexibility increased, got a bit optimistic 'maybe' and too few steps and weight, I have been very fortunate to have littl or no pain, I have soreness and pain today, Is this simply part process! . Thank you jj

[@peterguerrero4712]

How are feeling nowaday ? i have the same problem...

[@ReponMiah01]

sir the tibia bone was broken on the right ankle joint of my right leg . The doctor operated and put the plate and skewar on the broken bone and put the skewar on the left ankle for the support after the bones after the bones were hardened I opened the skew plate but xray showed that the skew holes were not filled now . I have pain in my left ankle joint when walk now I take calcium and vitamin D as regular supplement and hou long well take me to get back to normal

[@mamatalamsal8311]

Are you fine now?

[@keithdavis1625]

How long will it take in kids

[@tonyrichardstheavenger2021]

I did an xray for cyst turns out i had fracture from years ago that was untreated doctor said my 5th metacarpal was bended I was unaware of the fracture i skateboard get injuried and get back up again with no pain Now i found out i have this Even though i had no pain or complications for four year What should i do?

[@teccastar]

Tony Richards the avenger pray because God can help with anything also know Jesus Christ died for your sins and saved you

[@thelegendkiller4760]

After healing,, can it bear any heavy weight thing ????

[@quity1383]

THE LEGEND KILLER if it heals you can carry whatever you want

[@thelegendkiller4760]

xNightFury - Dragon oh many many thanx bro.... Pray for me.

[@quity1383]

THE LEGEND KILLER i am praying 💚, even me before 10 months I broke my arms it really pains as hell but it healed and now I can carry anything I want thank GOD 🙏💚

[@Doughhh23]

THE LEGEND KILLER

[@MharTumambing]

THE LEGEND KILLER

[@farooqahmadbhat9862]

Sir I unfortunately broke my tebia and ulna bone in accident 3 month back had surgery and Iron rod was used to fix it . I am walking with support of walker on advice of doctor with 40% body weight . Now I am in delima that doctor told me removal of screws is this safe.

[@sendit3251]

If it bothers you? Are you walking okay ? Did you remove it ?

[@faisalejaz3326]

In accident I have broken my leg tibia and fibula, but surgeon only treated tibia by insertion of IM rod in tibia through operation, and he didn't repaired fibula, according to him there is no need to repair fibula, it will heal by itself, it is not weight bearing bone, so no need to worry, is that so?

[@ramonlazo5944]

Yes you’re good bro, I broke my tibia and fibula as well while playing soccer 1 year and 5 months ago. The fibula repairs on its own. I also got a rod in my tibia and Im on the hard callus stage. It definitely takes time, it’s a slow and hard process.

[@mayaahmed943]

I've got tibia fracture how to know if it's recovering and what's good diet for fracture healing

[@jaskaransingh3627]

I've also fractured tibia and its been 3 months, my leg is in cast and I avoided surgery, can you suggest any kind of tips? And how is your leg now and how much time it took

[@atishdhujoo8074]

@@jaskaransingh3627 hi how is your leg??.. i have also broken tibia and fibula.. already 105day.. no weight bearing.. they put extrenal fixator.. after how many weeks you start learning to walk??

[@jaskaransingh3627]

@@atishdhujoo8074 My bones are fully healed and muscles are getting strong day by day. I am bearing full weight on my leg now and I am walking now. It took me total 7 months to get here as I've avoided surgery. Have you avoided surgery too?

[@atishdhujoo8074]

@@jaskaransingh3627 no i have done surgery.. already 105 day.. no weight bearing.. next appoint after 6weeks..

[@atishdhujoo8074]

@@jaskaransingh3627 doctor put external fixator.. am just waiting when i will start walking..

[@LiVeTeChY]

If movement of that bone happens does it take more time to heal

[@reignstars364]

Yes

[@liammulligan1279]

​@reignstars364 what can you do about movement when it's the upper fibula

[@Ahmed-uw2fd]

After how many months does remodling starts for femur fracture

[@ManjinderSingh-hs7uq]

Mian Ahmad bro are you able to normal walk and running after this fracture I

[@frosty129]

POV: you broke a bone and now watching this

[@reymarkmaningas8817]

I have a lump in my leg fructure it is natural or dangerous

[@byorder5671]

The exact same thing is happening to me. I’d like to know too

[@iamshintaro]

Reymark Maningas and By Order...did you undergo surgery or natural healing only? And is your leg already strong as before the fracture?

[@ahmedbesirmustafa1842]

اكو عرب بالطيارة

[@hoqueitacademy4796]

My tibia & fabua both are fracture last 14 weeks ago. Dr. start Non-operative treatment and using cast last 14 weeks and using TBR cast using from last 6 weeks. Now walking with a single crutch low weight bearing. My question, How long to need healing my legs? And How long i have been walking without crutch? Please tell me.

[@poojimusunuri]

Do hairline fractures increase height anyone?? And what is the healing process. Can any one say very important

[@drjdayakar]

no...it doesn't affect height

[@rajarajarajaraja5473]

Dr sar I hav Brock my leg bond in 2pis how much time it will take 2 healing

[@ManjinderSingh-hs7uq]

Raja Raja Raja Raja what type of fracture

[@ManjinderSingh-hs7uq]

Raja Raja Raja Raja aap pehle jese ho gye ho

[@sumanthr5031]

@Clint Eastwood 🤣🤣🤣

[@Yurembamdayanand]

I have done 2 operation in last 5 months but nothings improve, no bone healing now what i can do will you advise me for the right way. Thanks

[@Neptunejc]

Yurembam Dayanand I had the same thing open femur fracture no healing. I have a IM nail, my doc dynamized the nail. Took 2screws out from the top, and he made a small incision at the fracture site and scraped that area with the drill..To my surprise healing has started, I was told it had a small chance of working

[@wilddevil9967]

@@Neptunejc give me Mobil number

[@Neptunejc]

@@wilddevil9967 Instagram jayc1014

[@asmirpasalic5869]

I have broken fibula 2 years ago and it didnt healed for 3 months, does anyone knows why, in that time i have a lot of stress and depression, and i have eaten a lot of sugar products, my doctor says that is problem cos blood needed magnesium and kalcium from bones to neutralise blood sweetnes..

[@prasannakumar4946]

Brtr plz give your number

[@robertberin4872]

You should take calcium tablets

[@Garudanime]

High sugar diet kills bone healing, that was very dumb to do man.

[@mannukasana6059]

Did anyone give me some information because I have broken my forearm 3 months before but did not healing yet please

[@Joeldo._]

Mannu Kasana see the doctor ASAP

[@robertberin4872]

take calcium tablets

[@milijanb]

I have fisure on lower leg or "tibia", no dislocation of bone, how much time weeks need to heal the bone ? I'm 37 year old. Thanks 👋

[@mamatalamsal8311]

How much time did it took you? Please reply

[@milijanb]

@@mamatalamsal8311 I was 14 weeks in cast, after that I recover about 5 months to walk properly

[@adarshsingh6974]

You need a 4× button

[@kdsingh4848]

Treatment of broken bones without operation in 15 days just like before 100% guarantee

[@digitaltripuralive768]

My bone has broken 1 year ago I am not good walk

[@quantalor7157]

Was it your ankle ?

[@ManjinderSingh-hs7uq]

DIGITAL TRIPURA live what type of fracture

[@bhimprasadbhat464]

Totla

[@smilykhajuria4411]

Sir could you plzz tell me what amount of vitamin D is enough for patients having fracture?

[@Garudanime]

At least 1000iu a day, that's minimal, preferable 2000.

[@priscilliastev2984]

Uccarrrr

[@haridemihari]

Okurrrr..... - Cardi B.

[@GERMANFORLIFEMEL]

Aldi 10 my man doesn’t speak English ahaha frac-sureee

[@jasminekalu4569]

The whole words being used here I have to write it down one by one to go look for the meaning.. Why not use lay mans language and make it easy for us that ain't medical or orthopedic inclined

[@jasonMB999]

Lol

[@RafaelLopez-mv6to]

Hitter my real father I told u

[@marquesmodiano7090]

Speak English sir