Full transcript
0:00all right welcome back we are continuing
0:03on with Chapter six
0:04and open Stax today we will be looking
0:07at fractures and healing this would be a
0:10very short video there's there's not a
0:13lot here but still worth your time to to
0:17look at some of this medical terminology
0:19first of all when bones are fractured
0:23those fractures can vary from very minor
0:26you know to very very serious and you
0:31know the repair time that it takes
0:33varies dramatically depending on what
0:36what bone is injured and where it's
0:38injured and how badly it's injured and
0:41so this this video is really only going
0:43to touch on on the highlights of some of
0:45those processes but you know in an event
0:48let's let's put some of these things
0:49together first fracture there's may
0:52either result in the breaking of the
0:56skin the tearing of the skin and so that
0:59the bone actually projects outside of
1:01the body and that those are often
1:03referred to as compound fractures here
1:07in the list you'll you'll see it's known
1:08as an open fracture they also list a
1:11compound but open fractures are those in
1:13which the bone protrudes outside you
1:16know literally damage that the skin cuts
1:18the skin and protrudes outside so those
1:20are compound fractures and then you've
1:22got closed or simple fractures which
1:24occur completely internal just because
1:26they're simple by the way does not mean
1:28they are not traumatic it does not mean
1:31they're not serious it does not mean
1:32they're not life-threatening so the only
1:35difference in a compound in a simple
1:37fracture has to do with whether it has
1:39damaged the skin or not and whether
1:40there's a protection outside so that's
1:43important to recognize it doesn't it
1:44doesn't mean anything about whether it's
1:47simple to fix or more difficult to fix
1:50or anything like that so that so as you
1:52as you think about those two terms now
1:54as we look at the the terms at the top
1:57of this this list each of these may and
2:00in many cases refer to either a simple
2:02or a compound fracture so let's begin
2:05with a transverse fracture a transverse
2:08fracture is one that occurs where the
2:11fracture itself is exactly
2:13a straight across the long axis of the
2:17bone which means it would be perfectly
2:20perpendicular to the long axis basically
2:23making you know a clean break across the
2:27the shaft of the bone and so that would
2:30be called a transverse probably more
2:32often than not those breaks don't occur
2:35perfectly straight across and rather
2:37occur at some angle and when the break
2:40occurs at an angle it's referred to as
2:43oblique so oblique fractures are those
2:47that occur at some angle relative to the
2:50perpendicular axis of the shaft of the
2:52bone a spiral fracture occurs when a
2:57bone is twisted and the twisting results
3:00in some form a fracture now that
3:03fracture may be across the entire bone
3:05it may be only part only across part of
3:07the bone but spiral basically means that
3:11a bone has been twisted in some form and
3:13the result of it is as segments of it
3:16have pulled apart from each other and
3:17that's called a spiral fracture and and
3:21these sometimes can happen for example
3:23in a fall where you try to catch
3:25yourself with your hand
3:26sometimes the radius twists in such a
3:29way that you'll get a spiral fracture
3:30and it there's many many other bones
3:32that can be broken in a spiral form as
3:34well a the the other kinds of fractures
3:40in the list here include the the
3:42community fractures which these are very
3:46very traumatic fractures and that this
3:48occurs when you get a break in the shaft
3:50but the break is is at such a high force
3:55that it leaves small pieces of the bone
3:58or even sometimes large fragments of the
4:00bone between the two longer pieces this
4:04often happens when people fall from from
4:06a long height and the impact is it's
4:09such a force that it will break the bone
4:11and actually fracture the bone into
4:13pieces not just to you know not just a
4:16single simple fracture across but but a
4:19kind of a crushing force which leaves
4:21fragments of the bone in between the two
4:23two segments that's called common unit
4:25coming unit
4:27fracture an impacted fracture occurs
4:30from compression and this happens when
4:33when a bone is compressed in such a way
4:37that it breaks and then one piece is
4:39forced up into the other piece and as
4:44traumatic as that sounds it is that
4:46quite traumatic and and those are
4:48difficult fractures to set from a doctor
4:51standpoint finally there is the the
4:54greenstick fracture this is a fracture
4:57that only occurs on one side of the bone
4:59so these are minor fractures that don't
5:02completely cross and separate a bone
5:04into two pieces but rather just create a
5:07crack in the bone on one side or the
5:09other of a bone so a greenstick fracture
5:11now you can have you know these could be
5:13for example you could describe a
5:15fracture as closed that it were simple
5:17it could be a green strick tract a
5:19greenstick fracture and also be spiral
5:21so it's possible of a spiral fracture
5:23that's greenstick and would be described
5:25as simple so I want you to point out
5:28that each fracture might carry more than
5:30one of these terms okay well let's take
5:33a look at how fractures heal naturally I
5:36mean you do know that no doctors may be
5:40involved in setting the bone in such a
5:42way that it improves healing that's
5:44really quite important especially if you
5:45have something like a compound fracture
5:47where the bones just are not together
5:49those two things have to come back
5:51together at their ends to properly heal
5:54so there is that piece but once the two
5:56pieces are in alignment with one another
5:59as close to a in alignment as you can
6:01get the body will begin to heal itself
6:03and these are the the steps in that
6:05process the first step is is basically
6:08the formation of a hematoma and the
6:11hematoma is just a clotting and and so
6:14what happens is you know immediately
6:17once you get a break of a bone the blood
6:20vessels either in the periosteum or even
6:23in the medullary cavity or
6:26surrounding tissues will begin to bleed
6:29into that tissue area and it will fill
6:32the gap in the fracture here you can see
6:34an oblique fracture that's being filled
6:36with blood well that blood will
6:38eventually clot that usually happens
6:40quickly actually it happens within you
6:43know maybe just just less than a day
6:46you'll get a strong hematoma developing
6:48in a fracture and and then within an
6:52additional couple of days what you will
6:55get is the formation of what is referred
6:57to as an internal callus and an external
7:00Cal so if you look there and
7:01illustration be what you're seeing first
7:04is is or I'll show you first is this
7:06external callus the external callus is
7:09being formed by or it's being formed of
7:13both bone you're gonna get bone to begin
7:16filling into this this callus and also
7:18hyaline cartilage the Highland cartilage
7:21is being deposited by chondrocytes that
7:24you will find within the periosteum and
7:27the bone is being laid down by
7:30osteoblasts obviously which are also
7:32part of the internal cellular part of
7:34the periosteum so they are immediately
7:36within two to three days have laid down
7:38a pretty decent surrounding kind of a
7:42collar to the fracture that that you
7:45know extends from one end over to the
7:47other end and would ring the entire bone
7:49it's got an external callus it's pretty
7:51thin and this external callus is again
7:54made of of hyaline cartilage and some
7:56bone fragments within it on the inside
8:00you have in the end ostium there are
8:03some chondrocytes that are found within
8:05the endosteum
8:06that lay down a fibrocartilage kind of
8:09internal callus now the internal callus
8:12and the external callus will continue to
8:15to grow until they meet one another and
8:19and as they're doing that as they as
8:21they do that the same kind of thing that
8:23happens during endochondral ossification
8:26and I want you to hearken back and
8:28remember that that's where you'll get
8:30some of the chondrocytes that have
8:32secreted a substance around them and get
8:36get further and further away from any
8:38nutrient because remember in cartilage
8:41there is no blood vessel serving it and
8:42because of that they fail to get
8:45nutrients and through diffusion and
8:47eventually will begin to begin to die
8:50and as they are dying in hyper and they
8:52call it hypertrophy
8:54they begin to secrete substances that
8:56actually calcify the cartilage around
8:59them so that fiber cartilage begins to
9:01calcify and in the exact same way we
9:04learned about an endo chondral
9:05ossification osteo blasts begin to you
9:10know replace that the osteo class will
9:13resorb some of that and osteoblasts
9:16begin to replace that calcified
9:18cartilage with bone now the first bone
9:21that forms you can even see it here in
9:23this picture really well is a spongy
9:26type trabecular style bone so so here
9:29these trabecula you can begin to see if
9:31you look closely the picture the repair
9:34is originally going to be a spongy bone
9:35format but over the next couple of weeks
9:38that spongy bone begins to slowly be
9:42replaced by osteoclasts and osteoblasts
9:45working together to form a calm compact
9:49bone in the place where it used to be so
9:52the compact bone will will replace along
9:55the the core of the shaft of the bone so
9:58and the medullary cavity will return to
10:01normal because of the osteoclasts
10:04clearing the remaining spongy bone out
10:06of the way and the healed fracture
10:08although sometimes it does leave as you
10:11see here kind of an expansion area where
10:13if you look at the bone you can tell it
10:15was fractured in some cases you know
10:17depending on on how small and clean the
10:20fracture was it repairs in such a way
10:22that you know even on close examination
10:23of an x-ray you can't tell so they can
10:27repair that nicely they can remodel
10:29themselves into nearly perfect bones so
10:31okay well that covers section 6.5