The biology of fracture healing
Open accessAbstract
The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes. Although there is still much to be learned to fully comprehend the pathways of bone regeneration, the over-all pathways of both the anatomical and biochemical events have been thoroughly investigated. These efforts have provided a general understanding of how fracture healing occurs. Following the initial trauma, bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, commonly only obtained by open reduction and internal fixation. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodelling steps necessary. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus. This primary callus later undergoes revascularisation and calcification, and is finally remodelled to fully restore a normal bone structure. In this article we summarise the basic biology of fracture healing.
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Fracture healing in humans usually takes several weeks to months, depending on the fracture location, severity, and treatment.
“Fracture healing is a lengthy process that, in humans, usually takes several weeks to months, depending on the fracture location, severity, and treatment (1).”
From Methods to accelerate fracture healing – a narrative review from a clinical perspective (2024) · cites this paper as [1]
The Direct Fracture Healing section says complete healing can take a few months to a few years, while the Gap Healing section describes an initial phase lasting about 3–8 weeks. The paper supports a lengthy, variable process influenced by fixation, but does not establish that healing in humans usually finishes within weeks to months or that its duration depends specifically on fracture location and severity. Page numbers were unavailable in our copy. (LLM, conf=0.86)
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- Authors
- Marsell, R., & Einhorn, T. A.
- Affiliations
- Uppsala University Hospital (SE)
- Boston University (US)
- ORCID
- Einhorn, Thomas A.
- Venue
- Injury
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 42
- Issue
- 6
- Pages
- 551-555
- ISSN
- 0020-1383 (ISSN-L)
- PMC
- PMC3105171
- OpenAlex
- W2036557984
- Cited by
- 1,824
- References
- 49
- Citations by year
- 2026: 129 · 2025: 148 · 2024: 146 · 2023: 164 · 2022: 154 · 2021: 184 · 2020: 178 · 2019: 149 · 2018: 122 · 2017: 104 · 2016: 84 · 2015: 70 · 2014: 67 · 2013: 53 · 2012: 37
- FWCI
- 41.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Injury (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P01AR049920)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Bone Tissue Engineering Materials
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- fracture healing, bone regeneration, intramembranous ossification, endochondral ossification, acute inflammatory response, mesenchymal stem cells, cartilaginous callus, bone remodeling, gene expression
- MeSH terms
- Bone and Bones, Bone Regeneration, Female, Humans, Male, Tumor Necrosis Factor-alpha, Bone Remodeling, Fracture Healing, Inflammation Mediators, Fractures, Bone, Mesenchymal Stem Cells
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