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Healing: How do fractures heal?

The process that occurs after injury that restores continuity and function of the tissues. There is a gradual replacement of the injured and necrotic tissue by living tissue which then differentiates into bone, muscle, tendon etc. The process will be described in detail elsewhere. Basically there are 4 stages
  1. Inflammation: The damage to the bone and muscle, as well as the bleeding sets off an inflammatory reaction. The bleeding from the injury stops when the blood coagulates forming a blood clot. The early clot stimulates the growth of small capillary blood vessels from the surrounding normal tissue into the damaged area. As the blood supply increases the area swells and hurts. The vessels bring with them cells which lay down collagen fibres. (0-7 days)
  2. Soft Callus: The volume which was originally blood clot and dead tissue is replaced by scar tissue, collagen fibres laid down in a random fashion with a rich blood supply and nerve supply. Cartilage tissue may develop in soft callus. The rubbery tissue is strong enough to keep the bone fragments together as long as it isn't stressed too much. (7 days to 6 weeks)
  3. Hard Callus: Some of the cells in the soft callus differentiate into bone forming cells which produce bone mineral. This is laid down in the scar tissue to stiffen it. The result is "woven bone" bridging across from one fragment to another. It is 80% as strong as normal bone. (6 to 12 weeks)
  4. Consolidation: The woven bone is gradually remodelled into compact bone around the circumference of the bone and a medullary cavity is reformed. As a result the bone recovers almost all of its pre-injury strength. Remodelling is stimulated by stressing the bone moderately. (3 months to 18 months)

From: Myles Clough

Why does it take so long?


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 23 March 2017
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