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Case Studies in Fracture Healing and Nonunions

  • Joseph BorrelliJr.
  • Brent L. Norris
Chapter
  • 74 Downloads

Abstract

Fracture healing is a complex biological and biomechanical process that depends upon a sequence of factors to take place in an often-forgotten about biomechanical environment. Generally, fracture healing proceeds in one of two ways. When fracture fragments are brought directly into contact with each other and stabilized in a manner that limits motion, healing generally takes place by primary/direct bone healing. Primary bone healing includes both contact and gap healing, and in these scenarios fracture healing generally does not include callus formation. Secondary/indirect fracture healing generally occurs when the biomechanical environment during healing allows some motion at the fracture site. Secondary bone healing, unlike primary bone healing, includes the development of a soft callus comprised mostly of cartilage, followed by ossification of this soft callus, and eventually complete fracture healing and remodeling. When fractures fail to heal in the expected time frame, they are considered to be a nonunion. The multiple clinical examples in this chapter highlight the relationship between the biomechanical environment provided by external and internal means of fracture stabilization and the type of fracture healing to be expected. This chapter also includes a description of these types of fracture healing as well as a couple of examples of the approach and treatment of fracture nonunion.

Keywords

Primary/direct bone healing Secondary/indirect bone healing Nonunion Mesenchymal stem cells (MSC) Inflammation Callus Angiogenesis Fracture 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Joseph BorrelliJr.
    • 1
    • 2
  • Brent L. Norris
    • 3
  1. 1.BayCare Health SystemLutzUSA
  2. 2.Department of Orthopedic Surgery and Sports Medicine, Morsani College of MedicineUniversity of South FloridaTampaUSA
  3. 3.Department of Orthopedic TraumaUniversity of OklahomaTulsaUSA

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