Bone and Fracture Healing

- See: Bone Topics 
- Discussion:
    - woven bone healing:
          - ref: Distal radial fractures heal by direct woven bone formation
    - stages of enchondral bone healing:
          - hematoma / inflammation:

                 - shortest stage of fracture healing
                 - disruption of vascular flow through the marrow and periosteum
                 - infiltration of hematopoietic cells for hematoma formation, phagocytosis,
                           and reparative cytokine production

                 - ref: Human Early Fracture Hematoma Is Characterized by Inflammation and Hypoxia
          - endochondral ossification (chondrogenesis)
                 - low oxygen tension where woven bone develops to stabilize the fracture
          - remodeling / intramembranous ossification:
                 - strain results in the formation of collagen and intramembranous ossification;
                 - neovascularization, differentiation of mesenchymal stem cells into osteoblasts
                 - replacement of the cartilaginous callus by bone callus with remodeling;
                 - references:
                        - The four biomechanical stages of fracture repair. 
                        - Evidence for a humoral mechanism for enhanced osteogenesis after head injury.
                        - The biology of fracture repair. 

          - bone healing w/ plates: 
                  - pure compression and hydrostatic pressure causes mesenchymal cells to differentiate to chondrogenesis
                            and endochondral ossification;
                  - references:
                         - Evolution of the internal fixation of long bone fractures. choosing a new balance between stability and biology.
                         - Comparison of the effects of compression plates and external fixators on early bone-healing.
                         - Bone-healing patterns affected by loading, fracture fragment stability, fracture type, and fracture site compression.
                         - Motion Predicts Clinical Callus Formation: Construct- Finite Element Analysis of Supracondylar Femoral Fractures.
                         - Dynamic Stabilization with Active Locking Plates Delivers Faster, Stronger, and More Symmetric Fracture-Healing

    - bone vascular supply:
          - fracture healing depends on adequate blood supply.
                  - The vascular response to fracture micromovement.
                  - The effects of extraperiosteal and subperiosteal dissection. II. On fracture healing.
                  - The effects of extraperiosteal and subperiosteal dissection. I. On blood flow in muscle
         - fracture healing depends on periosteum:
                  - Periosteal and perichondral grafting in reconstructive surgery. 
                  - The presence of periosteum is essential for the healing of large diaphyseal segmental bone defects reconstructed with trabecular metal: a study in the femur of goats.
                  - The induction of neochondrogenesis in free intra-articular periosteal autografts under influence of CPM.

- Radiographic Determinants of Healing:  (non union)
          - restoration of cortical continuity (look for healing on 4 cortices - AP and lateral views); 
          - loss of distinct fracture line;
          - presence of callus (w/ IM nail or external fixator); 
          - references:
                  - Accuracy of radiologic assessment of tibial shaft fracture union in humans
                  - Correlations of radiographic analysis of healing fractures with strength: a statistical analysis of experimental osteotomies.  
    - age: 
          - references:
                   - Aging of bone tissue: mechanical properties.
                   - Age-related changes in properties of cortical bone. The importance of porosity, mineralization, and microstructure.
                   - Structural and cellular changes during bone growth in healthy children. 

- Negative Influences on Bone Healing: 

- Positive Influences on Bone Healing:

- Labs to Promote Bone Healing:
         - vitamin D, B12, DHEA, testosterone, E1, and E2, liver enzymes, and parathyroid hormone level.
         - ref: A study of male patients with forearm fracture in Northern Ireland.

- Induction of Bone Healing:
      - autograft / allografts:
      - bone morphogenic proteins: 
      - ultrasound:
              - Low intensity pulsed ultrasound accelerates delayed healing process by reducing the time required for the completion of endochondral ossification in the aged mouse femur fracture model.

      - electrical properties of bone:
              - bone loaded in compression will cause an electronegative field;
              - bone loaded in tension will cause an electropositive field;
              - references:
                       - Treatment of recalcitrant non-union with a capacitively coupled electrical field. A preliminary report.
                       - Intraoperative measurement of bone electrical potential: a piece in the puzzle of understanding fracture healing. 

The biology of fracture healing in long bones
Repair of segmental bone defects in the rat: an experimental model of human fracture healing.
Effect of intense physical activity on the bone-mineral content in the lower limbs of young adults.
Humeral hypertrophy in response to exercise.
The science of fracture healing.
Indirect reduction brought surgeons back to basics
Immobilizing the fracture: nonsurgical fracture treatment
Non Sine Gloria
Use of clinical assessment tools in the evaluation of fracture healing

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, June 11, 2018 6:44 pm