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Fracture healing

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Abstract

Bone healing is unusual because the repair tissue is similar to the original tissue: bone rather than scar tissue is formed. may be a better term than repair. The rational basis for fracture treatment is the interaction between three elements: the cell biology of bone regeneration, the revascularization of injured bone by the surrounding soft tissues, and the mechanical environment of the fracture. The surgeon should be aware of, and consider, the interaction between these elements when choosing the optimal treatment of a clinical patient. This chapter reviews direct bone healing; indirect bone healing; mechanical manipulation of fracture healing.

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Figures

Image of 5.1
5.1 Bilateral femoral fractures in a Labrador Retriever. (a) Left leg. (b) Right leg. When the major fracture fragments have been realigned, the oblique fracture has higher strain conditions than the comminuted fracture due to the shorter length of its fracture gap.
Image of 5.2
5.2 Histological appearance of direct cortical bone healing. The areas of dead and damaged bone are replaced internally by Haversian remodelling. The fracture line has been graphically enhanced. (Reproduced from with permission from the publisher)
Image of 5.3
5.3 Diagrammatic representation of Figure 5.2 . The osteon carries at its tip a group of osteoclasts that drill a tunnel into the dead bone. Behind the tip, osteoblasts form new bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 5.4
5.4 (a) Preoperative and (b) 6-week postoperative radiographs of a 6-month-old Boxer puppy. Despite the use of an intramedullary pin and cerclage wires, technical errors result in fracture instability. As the diameter of the bone increases due to callus production, so does the resistance to bending forces.

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