THE BIOLOGY OF BONE REPAIR AND REGENERATION
Keywords:
Vascularization; Mechanical stability; Interfragmentary motion; Callus formation; Intracortical remodeling; Haversian remodeling; Hematoma; Granulation tissue; Connective tissue; Fibrocartilage; Woven bone; Compact bone; Differentiation cascade; Nonunion; Pseudarthrosis; Osteosynthesis; Fracture fixation; Biomechanical environment;Abstract
Bone healing is a biologically and mechanically regulated process that requires sufficient blood supply, osteogenic cells, and appropriate stability. The degree of interfragmentary motion determines the healing pathway, which may occur as primary bone healing under absolute stability, secondary bone healing with callus formation under relative stability, or may fail, resulting in nonunion. Primary healing involves direct intracortical remodeling without callus, whereas secondary healing progresses through a cascade of tissue differentiation from hematoma to mature bone. Disruption of mechanical stability or biological conditions can lead to delayed union or nonunion, highlighting the importance of optimizing both biological and biomechanical factors in fracture management.