FRACTURES of the UPPER EXTREMITY
Exam Q&A 100% Guaranteed Pass
Generally, fractures heal by _____ in children and ______ in adults - ✔✔3-
4 weeks
4-6 weeks
Most important factor in fracture healing is _________. - ✔✔blood supply
Smoking (nicotine) and systemic diseases (diabetes) have been found to
________ healing time - ✔✔increase
Inflammatory stage - ✔✔Development of hematoma and traumatic
inflammation
Hematoma is gradually replaced by granulation tissues around fracture
ends
Begins immediately after injury and last several days
Swelling and hypoxia are present
Inflammatory cells migrate into the area
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,Fibroblasts, mesenchymal cells and osteoprogenitor cells present
Reparative stage-organization - ✔✔Overlaps the inflammatory stage
Occurs within two weeks of injury
Pain usually decreases in this stage
Union by callus
Direct Healing (Primary Healing)
Indirect Healing (Secondary Healing)
Direct Healing (Primary Healing) - ✔✔Occurs with rigidly immobilized
fractures (i.e., plate and screws)
An implant replaces external callus
Primary healing does not hasten union but ensures it
Union occurs by direct bone healing across the fracture site
Indirect Healing (Secondary Healing) - ✔✔Motion at the fracture site
stimulates healing
Callus formation is stimulated by motion at the fracture site
Enchondral calcification occurs
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,Fibroblasts and chondroblasts need to be present to sustain the
environment long enough for osteoblastic bone replacement
Indirect Healing (Secondary Healing)
5 factors are necessary: - ✔✔Hematoma
vibrant diversified cell populations to ensure healing progression/nutrition
adequate blood supply
evolving scaffold for cellular differentiation
mechanical environment of relative stability that minimizes fragment strain
Remodeling phase - ✔✔- As the callus forms, pain should diminish
significantly and with mature callus associated swelling, pain and
tenderness will diminish rapidly
- Remodeling of immature trabecular bone eventually evolves into compact
lamellar bone
Remodeling may continue for years but radiographic union occurs within
the first few months
Primary Fracture Healing - direct union
inflammatory phase: and time frame
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, POC
Regeneration Phase:
Remodeling Phase: - ✔✔Inflammatory Phase: surgery - day 21
-Protection with intermittent AROM out of splint; RICE
Regeneration Phase: 1-6 weeks
-AROM, PROM and splinting can be started sooner than in the secondary
healing reparative phase
Remodeling Phase: 6 weeks to 1 year
-Diverse exercise program is allowed
Fracture Healing Stages Occurring with Secondary Healing
Inflammatory Phase:
Reparative Phase:
Remodeling Phase: - ✔✔Inflammatory Phase: Injury to day 5
* treat by protection (immobilization) protect hematoma; RICE
Reparative Phase: day 5- day 21
* protect fracture callus with removable splint; intermittent motion
4
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
Exam Q&A 100% Guaranteed Pass
Generally, fractures heal by _____ in children and ______ in adults - ✔✔3-
4 weeks
4-6 weeks
Most important factor in fracture healing is _________. - ✔✔blood supply
Smoking (nicotine) and systemic diseases (diabetes) have been found to
________ healing time - ✔✔increase
Inflammatory stage - ✔✔Development of hematoma and traumatic
inflammation
Hematoma is gradually replaced by granulation tissues around fracture
ends
Begins immediately after injury and last several days
Swelling and hypoxia are present
Inflammatory cells migrate into the area
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,Fibroblasts, mesenchymal cells and osteoprogenitor cells present
Reparative stage-organization - ✔✔Overlaps the inflammatory stage
Occurs within two weeks of injury
Pain usually decreases in this stage
Union by callus
Direct Healing (Primary Healing)
Indirect Healing (Secondary Healing)
Direct Healing (Primary Healing) - ✔✔Occurs with rigidly immobilized
fractures (i.e., plate and screws)
An implant replaces external callus
Primary healing does not hasten union but ensures it
Union occurs by direct bone healing across the fracture site
Indirect Healing (Secondary Healing) - ✔✔Motion at the fracture site
stimulates healing
Callus formation is stimulated by motion at the fracture site
Enchondral calcification occurs
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,Fibroblasts and chondroblasts need to be present to sustain the
environment long enough for osteoblastic bone replacement
Indirect Healing (Secondary Healing)
5 factors are necessary: - ✔✔Hematoma
vibrant diversified cell populations to ensure healing progression/nutrition
adequate blood supply
evolving scaffold for cellular differentiation
mechanical environment of relative stability that minimizes fragment strain
Remodeling phase - ✔✔- As the callus forms, pain should diminish
significantly and with mature callus associated swelling, pain and
tenderness will diminish rapidly
- Remodeling of immature trabecular bone eventually evolves into compact
lamellar bone
Remodeling may continue for years but radiographic union occurs within
the first few months
Primary Fracture Healing - direct union
inflammatory phase: and time frame
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, POC
Regeneration Phase:
Remodeling Phase: - ✔✔Inflammatory Phase: surgery - day 21
-Protection with intermittent AROM out of splint; RICE
Regeneration Phase: 1-6 weeks
-AROM, PROM and splinting can be started sooner than in the secondary
healing reparative phase
Remodeling Phase: 6 weeks to 1 year
-Diverse exercise program is allowed
Fracture Healing Stages Occurring with Secondary Healing
Inflammatory Phase:
Reparative Phase:
Remodeling Phase: - ✔✔Inflammatory Phase: Injury to day 5
* treat by protection (immobilization) protect hematoma; RICE
Reparative Phase: day 5- day 21
* protect fracture callus with removable splint; intermittent motion
4
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
