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      The biology of fracture healing.

      1 ,
      Injury
      Elsevier BV

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          Abstract

          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 remodelling 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 revascularisation and calcification, and is finally remodelled to fully restore a normal bone structure. In this article we summarise the basic biology of fracture healing.

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          Author and article information

          Journal
          Injury
          Injury
          Elsevier BV
          1879-0267
          0020-1383
          Jun 2011
          : 42
          : 6
          Affiliations
          [1 ] Department of Orthopaedic Surgery, Uppsala University Hospital, Entrance 61, Uppsala SE-75185, Sweden. richard.marsell@surgsci.uu.se
          Article
          S0020-1383(11)00125-2 NIHMS288299
          10.1016/j.injury.2011.03.031
          3105171
          21489527
          8177dcd0-cc08-41f1-ab6d-fb393756e6b3
          Copyright © 2011 Elsevier Ltd. All rights reserved.
          History

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