Hematoma Formation In Bone

Bone is a dynamic living tissue that is made up of metabolically active cells that are integrated into a rigid framework, 30% organic matrix, and 70% minerals. A vascular network of nutrient, metaphyseal, and periosteal vessels richly supplies adult bone. In a fracture or fusion model, the healing potential of bone, is decided by a variety of systemic and local factor including biochemical, biomechanical, cellular, hormonal, and pathological mechanisms. An incessantly occurring state of bone deposition, resorption, and remodeling facilitates the healing process (Kalfas, 2001). A lot of growth factors and regulatory proteins have been interlaced in bone repair. Regarding these matter, transforming growth factor-B appears to be the major regulator

A hematoma or collection of blood is developed within the fracture site during the first few hours and days in the inflammatory stage. Bone fracture ruptures associated blood vessels resulting in blood clot that creates a fibrin mesh which seal the fracture site scaffold to recruit inflammatory cells (macrophages, monocytes, lymphocytes and polymorphonuclear cells), fibroblasts and endothelium which infiltrate the bone under prostaglandin mediation. This results in the formation of granulation tissue, ingrowth of vascular tissue and migration of mesenchymal cells. Degranulated platelets and marauding inflammatory cells subsequently release a host of cytokines, for instances, platelet-derived growth factor and fibroblast growth factor that activate bone progenitor cells. Within a week, the involved tissue is ready for matrix synthesis. The primary nutrient and oxygen supply of this early process is provided by the exposed cancellous bone and muscle. The use of anti-inflammatory or cytotoxic medication during this 1st week may alter the inflammatory response and inhibit bone healing (Kalfas,

The bone healing is completed during this phase in which the healed bone is restored to its normal morphology and functions. This phase is a slow process and it may take several weeks or months before the bone is completely normal as pre-injury state. The growth rate of re-modelling of the bone healing is difference between adult and child’s bone. For example in the upper limb fracture of an adult, the bone fractures takes about 6 weeks to heal compared to a child, the bone only take a shorter time about 3 weeks to be properly healed (Solomon, Warwick, 2014). This is due to the highly vascularization to the fractured bone in a children. The bone alignment also closely monitored at this final phase. Good, normal bone alignment indicated the fractured bone was healed properly without any complication (Keramaris et. al,