THE BIOLOGY OF FRACTURE HEALING

By R. Marsell, T. Einhorn. Injury, 2011

1,751 citations recorded by the source corpus.

The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes. Although there is still much to be learned to fully comprehend the pathways of bone regeneration, the over-all pathways of both the anatomical and biochemical events have been thoroughly investigated. These efforts have provided a general understanding of how fracture healing occurs. Following the initial trauma, bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, commonly only obtained by open reduction and internal fixation. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodeling steps necessary. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus. This primary callus later undergoes revascularization and calcification, and is finally remodeled to fully restore a normal bone structure. In this article we summarize the basic biology of fracture healing.

Subfields: Epidemiology, Molecular Biology, Surgery

View Paper: https://www.semanticscholar.org/paper/da98027c8b50c6c3d39622f9d37cd0324e9c8d7c

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In Epidemiology

1. A. Ignatius
2. Lutz Claes
3. B. Olsen
4. Kai Hu
5. S. Recknagel

In Molecular Biology

1. B. Olsen
2. Kai Hu
3. S. Goodman
4. Zhenyu Yao

In Surgery

1. Dietmar Werner Hutmacher
2. S. Goodman

Citations in the corpus

• Mesenchymal stem cell-macrophage crosstalk and bone healing (2018, background): “bone, bone is restored to its pre-fracture structure and integrity [7, 10].”
• Inflammation, Fracture and Bone Repair (2016, background): “and replaced by granulation tissue rich in proliferating mesenchymal cells and developing neovasculature embedded in an unorganized extracellular collagen matrix [7,18,23,47].”
• The roles of vascular endothelial growth factor in bone repair and regeneration (2016, background): “Facture healing, the most common form of bone repair, is characterized by several overlapping stages, namely, an inflammation phase, soft callus phase, cartilage turnover (replacement by bony callus) phase and bone remodeling phase [53].”
• Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective (2013, positive): “In contrast to most other organs in the human body, bone tissue is capable of true regeneration, i.e. healing without the formation of fibrotic scar tissue (21).”
• Fracture healing under healthy and inflammatory conditions (2012, background): “The acute inflammatory response occurs over the first 7 days after fracture in rats ( Figure 5a ), and maximum levels of IL-6 and IL-1β are reached within the first 24 h”