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Bone Anatomy and the Biologic Healing Process of a Fracture

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Bio-orthopaedics

Abstract

Bones are dynamic tissues with a great organization in structure not only a static support also with a great cellular and mineral capacity. The biology of bone fracture healing is a very complex process, through the understanding of the healing phases, is critical. Fracture healing can be divided into two main categories: primary bone healing and secondary bone healing although both healing responses can interact. Primary bone healing is similar to the bone remodeling which occurs under low interfragmentary movement or rigid fixation and under compression. Secondary bone healing is associated with motion on the fracture site, involves an inflammatory response and hematoma formation, repair phase (soft callus and hard callus), and remodeling. After a fracture blood vessels disruption, it leads to hematoma formation and the hematoma is intruded with immune cells; an inflammatory response elicits with pro-inflammatory cytokines IL-1, IL-6, TNF-α, and IFN-ϒ. The control of inflammatory response is critical for further process. After resolution of the inflammatory response, mesenchymal stem cells accumulate to the fracture side and differentiate into chondrocytes and osteoblasts. Further, with the controlled activity of macrophages, T- and B-lymphocytes, cytokines, and growth factors, soft callus is produced with endochondral formation followed by hard callus. Fracture healing is completed by the remodeling phase characterized by the balance between osteoblast and osteoclast functions under both systemic and local control pathways.

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Abbreviations

BMPs:

Bone morphogenetic proteins

CXCL:

Chemokine motif ligand

DMP1:

Dentin matrix protein

ECM:

Extracellular matrix

FGF-1:

Fibroblast growth factor-1

GMCSF:

Granulocyte-macrophage colony-stimulating factor

IFN-ϒ:

Interferon-ϒ

IGF-1:

Insulin-like growth factor

IL1-ra:

IL-1 receptor antagonist

M-CSF:

Macrophage colony-stimulating factor

MCP-1:

Monocyte chemotactic protein-1

MEPE:

Matrix extracellular phospho-glycoprotein

MIP-1 α:

Macrophage inflammatory protein-1 α

MMPs:

Matrix metalloproteinases

MSCs:

Mesenchymal stem cells

NK cells:

Natural killer cells

OPG:

Osteoprotegerin

PBMCs:

Peripheral blood mononuclear cells

PDGF:

Platelet-derived growth factor

PMNs:

Polymorphonuclear neutrophils

PTH:

Parathyroid hormone

RANKL:

Receptor activator of nuclear factor kappa-B ligand

SDF-1:

Stromal derived factor-1

TGF-β:

Transforming growth factor beta

TLRs:

Toll-like receptors

TRAP:

Tartrate resistant acid phosphatase

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Ersin Ercin & Onder Murat Hurmeydan

  2. Department of Orthopaedics and Trauma Surgery, Acıbadem University School of Medicine, Istanbul, Turkey

    Mustafa Karahan

Authors
  1. Ersin Ercin
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  2. Onder Murat Hurmeydan
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  3. Mustafa Karahan
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Correspondence to Ersin Ercin .

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Editors and Affiliations

  1. O.A.S.I. Bioresearch Foundation NPO, Milan, Italy

    Alberto Gobbi

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  3. Musculoskeletal and Joint Research Foundation, San Diego, California, USA

    John G. Lane

  4. Department of Orthopedics, Acibadem University, Istanbul, Turkey

    Mustafa Karahan

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Ercin, E., Hurmeydan, O.M., Karahan, M. (2017). Bone Anatomy and the Biologic Healing Process of a Fracture. In: Gobbi, A., Espregueira-Mendes, J., Lane, J., Karahan, M. (eds) Bio-orthopaedics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54181-4_34

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