Factors affecting Fracture Healing

January 9, 2021 || By : Dr. MhmadFarooq || Basic Science


  • Factors affecting Fracture Healing include Systemic Factors and Local Factors.
  • Fracture healing is a complex process that requires the recruitment of appropriate cell (fibroblasts, macrophages, chondroblasts, osteoblasts, osteoclasts) and the subsequent expression of the appropriate genes (those that control matrix production and organization, growth factors, transcription factors) at the right time and in the right anatomical location.

What are the Factors affecting Fracture Healing?

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, parathyroid hormone, prostaglandins)
  5. Diseases: diabetes, anemia, neuropathies, tabes
  6. Vitamin deficiencies, A, C, D, K
  7. Drugs: nonsteroidal anti inflammatory drugs (NSAIDs), anticoagulants, factor XIII, calcium channel blockers (verapamil), cytotoxins, diphosphonates, phenytoin, 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
    a. Radiation necrosis
    b. Infection
    c. Tumors and other pathological conditions
  3. Denervation

B. Factors depending on injury:

  1. Degree of local damage:
    a. Compound fracture
    b. Comminution of fracture
    c. Velocity of injury
    d. 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, over distraction)
  6. Factors stimulating posttraumatic osteogenesis (bone grafts, bone morphogenetic protein, electrical stimulation, surgical technique, intermittent venous stasis)

D. Factors associated with complications:

  1. Infection
  2. Venous stasis
  3. Metal allergy

Factors affecting Fracture Healing From Uhthoff HK: Fracture healing. In Gustilo RB, Kyle RF, Templeman DC: Fractures and dislocations, St. Louis, 1993, Mosby.

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