Bones can heal either by 'Healing Per Primam' or secondary healing with callus formation (much more common).
Healing per primam is direct healing of bone with tunneling of osteoclasts and migration/colonization of the tunnel with osteoblasts (no callus formation).
Secondary healing/callus formation stages:
- Hematoma
- Granulation tissue
- (Soft callus) Cartilaginous callus formation
- (Hard Callus) Bony callus and cartilaginous remnants (lammellar bone deposition)
- Remodelling to original bone contour
Stephen Pearson strain theory, classification of fracture with regards to healing:
> Narrow simple line > OPEN reduction
Requires absolute stability, usually a surgical fix with plates and screw so there is zero movement of bone fragments. healing per primam
e.g. this type of healing is ideal for fractures where we don't want a callus for example, joint fractures, fractures of the epiphysis (a callus would restrict movement).
> Wide complex line > CLOSED reduction
Requires relative stability, fix fracture with plaster cast or erfix etc. healing is by secondary bone healing with callus formation.
e.g. comminuted fractures, fractures with gaps and mutiple fragments.
