Musculoskeletal system.

The wounds can be open or closed. Open wounds are common because the shaft of the tibia is just below the skin and subcutaneous tissue and is not covered with much soft tissue. Most of the tibial shaft fractures are associated with fibular fractures too. In Julia, the fracture occurred due to high speed accident. The fibula was however not involved and the wound was closed.

The main sources of pain in Julia are the site of fracture, skin and subcutaneous tissue and the muscles surrounding the tibia. Fracture induces significant amount of inflammation and release of inflammatory mediators with cause pain, swelling, warmth and redness. During fracture, hematoma may be formed which can also cause pain (Rosenberg, 2007).

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Inflammatory cells, phagocytes and fibroblasts have a major role in the healing process of the fracture. Fracture causes formation of hematoma and a blood clot gets formed between the broken fragments of the fracture. After the initial few days following fracture, blood vessels grow within the clot. These blood vessels allow accumulation of phagocytes to the area which help in the removal of dead tissue. The blood vessels also cause pouring in of fibroblasts which multiply in the walls of the blood vessels and produce collagen fibres. These fibres replace the blood clot. The fibroblasts also lay down bone matrix or calcium hydroxyapatite which helps in the transformation of collagen to bone (Rosenberg, 2007).

Factors which promote wound healing in Julia are immobilization, good nutrition, young age and absence of infection (Rosenberg, 2007. Konowalchuk, 2005 and Norvell, 2009). Immobilization is very essential to promote fracture healing. This is because, any movement of the fragments of the fracture hinder the process of healing. Movement disturbs the formation of clot and invasion of blood vessels within the clot.

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