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Fracture healingDr Roberto Schubert et al. Fracture healing?occurs naturally after traumatic bony disruption. This process?begins with hemorrhage and progresses through three stages:inflammatoryreparativeremodelingThis process can be supported by various treatment options with immobilisation a mainstay, and inappropriate treatment?may result in a variety of complications. Depending on the fracture site, normal?healing may take from 3-12 weeks.?Normal fracture healingFor normal fracture healing to occur a number of requirements must be met:viabilty of fragments (i.e. intact blood supply)mechanical rest: this can be achieved by not moving and external immobilisation, e.g. cast or internal fixationabsence of infectionThe process of healing is different depending on the configuration of the fracture fragments and can be divided into three main categories:spontaneous (indirect/secondary) healingcontact (angiogenic/primary) healinggap healingSpontaneous (indirect/secondary) healingThis is the most common 'natural' healing process, whereby the fracture ends are?placed close to each other (but not "apposed"), with intervening haematoma and variable displacement and/or angulation.?Though the healing process of a fracture can be divided into various phases, it should rather be understood as a a biological continuum. The periosteum, endosteum, and Haversian canals are the sources of pluripotent mesenchymal cells?that initiate the formation of the healing tissues (three blastema theory). The bridging callus seen on radiographs mainly arises from the periosteum.The process of fracture healingThe fracture haematoma initiates the healing response. Within 48 hours, chemotaxic signaling mechanisms attract the inflammation cells necessary to promote the healing process.Within 7-14 days, granulation tissue is formed between the fragments, leading to vascularisation of the haematoma. On radiographs, there may be increased translucency of the fracture during this stage, due to bone resorption.Cells within the granulation tissue proliferate and begin to differentiate into fibroblasts and chondroblasts. They produce an extracellular organic matrix of fibrous tissue and cartilage, wherein woven bone is deposited by osteoblasts. This stage usually lasts 4-16 weeks. The newly formed callus is still damageable by shear forces, whereas axial traction and pressure promote the matrix formation.The mesh of woven bone is then replaced by lamellar bone, which is organized parallel to the axis of the bone.Eventually, remodeling of the bone takes place, restoring its normal cortical structure depending on load distribution. This is an ongoing process that may last for several years. ................
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