Pathophysiology Case Study
Provide a Pathophysiology Case Study
For a bone fracture to heal, it has to go through stages of healing to ensure full recovery. These bone-healing stages include forming the hemotoma, cartilage callus formation, bony callus formation, and the remodelling of the bone.
The formation of the hemotoma happens within the first five days of the fracture of the bone. During the fracture, blood vessels that supply blood to the bone are usually ruptured, causing blood to collect outside of the blood vessels around the fractured bone, also known as a hemotoma. While the blood collects out of the blood vessels in a hemotoma, it clots, forming a frame where the healing will start. The fractured bone causes the body to produce an anti-inflammatory response like cytokines, revitalizing the body to have cellular reproduction on the fracture site (Sheen & Garla, 2020). As the new cells forms, there are white blood cells at the site that lead to the removal of necrotic tissue around the fracture, while cytokines help stimulate healing.
Around the sixth to the eleventh day, the cartilage callus formation around the fractured bone is the second stage of bone healing. Angiogenesis is stimulated around the fractured site, where the production of tissues is rich in fibrin. The fibrin-rich tissues act as a base for where stem cells are brought about and these forms a network of collagen-rich tissues. The collagen network over the fibrin tissues forms a cartilage part of the hyaline cartilage sleeves (Sheen & Garla, 2020). The cartilage sleeves work hand in hand with the adjoining periosteal layers that wove around osteoprogenitor cells to start the bone formation process.
The third stage of the bone healing stage occurs between the 11th and 28th day after the fracture. The cartilage callus formed over the first ten days after the fracture acts as a base of the endochondral ossification process. During this process, cells are further stimulated to differentiate between osteoblasts, chrondoblasts, chodnroclasts, and osteoclasts, where the cartilage-based callus begins to calcify by absorbing calcium from the blood vessels (Sheen & Garla, 2020). As calcium infuses into the woven formed bone, new blood vessels formed around the fractured area multiply, infusing more calcium into the bones with more stem cells increasing. Ultimately, the bony callus formed starts to harden into fragile bones.
The last of these stages is the remodelling of the bone that happens between the 18th day onwards as the patient with the fractured bone starts recovery and movement. During this period, the hardening of the bony callus and migration of differentiated bone cells down into specific areas in the bone will lead to the restructuring of the bone from its fractured state into its original formation (Sheen & Garla, 2020). While the cells migrate down with multiplied blood vessels that pump more calcium and nutrients into the bony callus, it leads to a more hardened and compact calcified bone. The bony callus is slowly replaced with the lamellar bone that slowly goes through the remodelling process over a few months. Over the months of recovery and physiotherapy sessions, the bone is fully remodelled into how the bone normally looks.
The best diagnosis of hemarthrosis is by conducting a physical exam and performing the arthrocentesis procedure. Through the process of arthrocentesis, a needle is used to remove excess fluid from the knee joint through aspiration (Lombardi & Cardenas, 2020). When the knee joint’s synovial fluid is aspirated, hemarthrosis should be visible with blood in the joint, as hemarthrosis is a condition where there is bleeding present in the knee joint. Question 2b.
While looking into hemarthrosis, a doctor should aspirate synovial fluid from the knee joint and look for the presence of blood. If a joint has blood, this is an indication of hemarthrosis in the patient.
While performing the arthrocentesis procedure as a way of diagnosis, the doctor or physician in charge will be looking into the presence of blood in the synovial fluid aspirated. An MRI is essential after detecting blood in the synovial fluid in identifying the source of bleeding that causes the blood to sip into the knee joint’s synovial fluid (Lombardi & Cardenas, 2020). By identifying the blood vessel that is ruptured, causing the bleed into the synovial fluid, the physician will find a way to prevent excessive bleeding and a course of treatment for the inflamed knee joint.
Lombardi, M., & Cardenas, A. C. (2020b). Hemarthrosis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK525999/#:~:text=Hemarthrosis%20is%20bleeding%20into%20a
Sheen, J. R., & Garla, V. V. (2020). Fracture Healing Overview. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551678/