Bone Repair

Prepared by:
Jade Kenneth Lomansoc
• Most of the phases of healing resemble those
observed in dermal healing
• As in dermal healing, the process of union is
mediated by soluble growth factors and cytokines
• By stimulating the differentiation of mesenchymal
cells into chondroblasts and osteoblasts, BMPs (Bone
Morphogenetic Proteins, which belong to the TGF-β
superfamily) directly affect bone and cartilage repair
• Other growth factors such as PDGF, TGF-β, TNF-α and
bFGF also participate in bony repair by mediating
inflammatory and proliferative phases of healing
 Bone Healing
• Hematoma formation

• Liquefaction and degradation

• Revascularization

• Soft callus stage

• Hard callus stage

• Remodeling
 Hematoma formation
• Initial stage of hematoma formation consists
of an accumulation of blood at the fractured
site, which also contains devitalized soft
tissue, dead bone, and necrotic marrow
 Liquefaction and Degradation
• Next stage to hematoma formation,
accomplishes the LIQUEFACTION AND
DEGRADATION of nonviable products at the
fractured site.
 Revascularization
• Normal bone adjacent to the injury site
undergo revascularization, i.e. new blood
vessels grow into the fractured site
• Similar to the formation of granulation tissue
in soft tissue
• Symptoms associated are characteristics of
inflammation, with clinical evidence of
swelling and erythema
 Soft callus stage
• Three to four days following injury, soft tissue forms a bridge
between the fractured bone segments
• This soft tissue is deposited where neovascularization has
taken place
• Serves as an internal splint, preventing damage to the newly
laid blood vessels and achieving a fibrocartilaginous union
• Formed externally along the bone shaft and internally
within the marrow cavity
• Clinically, this phase is characterized by the end of pain and
inflammatory signs
 Hard callus stage
• Consists of mineralization of the soft callus
and conversion to bone
• May take up to 2 to 3 months and leads to
complete bony union.
• Afterwhich, bone is now considered strong
enough to allow weight bearing and will
appear healed on radiographs
 Remodeling
• Excessive callus is absorbed and the marrow
cavity is recanalized
• This remodeling allows for the correct
transmission of forces and restors the
contours of the bone