Bones fracture frequently and often result in significant impairments, functional limitations, and

disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the
skeletal tissue organization and a loss of mechanical integrity. The goal of fracture healing is to
regenerate mineralized tissue in the fracture area and restore mechanical strength to the bone. Of equal
importance is the reconstitution of the normal soft tissue gliding and movement about the fracture site.
This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and
molecular biology, which should help the reader better understand the current mechanisms related to
bone healing (primarily and secondarily). Fracture fixation modes also are described along with the
temporal sequencing as to when to protect or move the fractured region.(1)

Those of us who have experienced a significant fracture likely recall first the pain of the injury, then we
often focus our attention on the prospect of time in a cast or other form of extended immobilization. We
imagine the discomfort and limitations that will ensue, and after all else settles down, we often wonder,
" How strong are my bones anyway, and will I fracture again? " Nature, on the other hand, has no such
questions, but moves swiftly to initiate healing. Guided by a complex intelligence that we do not yet fully
understand, bone repairs itself — and over a few months is made whole again. The fracture self‐repair
process is spontaneous, natural, and seeks no direction from us, but what we do during this time is of
unrecognized importance. The stage we set for healing greatly influences the speed, comfort, and
completeness of the bone renewal process. Further, life‐ supporting changes made in response to a
fracture can strengthen our entire skeleton and reduce the likelihood of future fractures. Physiology of
fracture healing Fracture healing involves complex processes of cell and tissue proliferation and
differentiation. Many players are involved, including growth factors, inflammatory cytokines,
antioxidants, bone breakdown (osteoclast) and bone‐building (osteoblast) cells, hormones, amino acids,
and uncounted nutrients. Fracture healing can be divided into three phases. The inflammation phase is
the first stage of healing. Immediately upon fracture, a blood clot forms, allowing the influx of
inflammatory, clean‐up cells to the wound area. This is followed by a cytokine cascade that brings the
repair cells into the fracture gap. These cells immediately begin to differentiate into specialized cells that
build new bone tissue (osteoblasts) and new cartilage (chondroblasts). Over the next few months, these
cells begin the repair process, laying down new bone matrix and cartilage. At this initial stage, osteoclast
cells dissolve and recycle bone debris. The second, reparative stage begins about two weeks after the
fracture occurs. In this stage, proteins produced by the osteoblasts and chondroblasts begin to
consolidate into what is known as a soft callus. This soft, new bone substance eventually hardens into a
hard callus as the bone weaves together over a 6‐ to 12‐week time period. The final step of fracture
repair is known as the remodeling phase. At this stage the callus begins to mature and remodel itself.
Woven bone is remodeled into stronger lamellar bone by the orchestrated action of both osteoblast
bone formation cells and osteoclast bone resorption cells.(2)

The healing of a fracture is one of the most remarkable of all the repair processes in the body since it
results, not in a scar, but in the actual reconstitution of the injured tissue in something very like its
original form. It is not to be expected therefore that the mechanisms controlling such a process will be
easily elucidated and indeed they involve problems of cellular homeostasis which are among the most
fundamental in biology. If it is not quite the “cunning’st pattern of excelling nature” then it is something
quite close to it and a great deal of that pattern at present stands unrevealed. However, this review is
primarily concerned with those features which have direct clinical relevance and it is fortunately
possible to treat fractures successfully without a complete understanding of the cellular mechanisms
involved without at the same time relying entirely on empiricism. A number of factors influence the
healing which can be identified from both clinical and experimental work and may be taken into
consideration to put treatment on a more rational basis. It is with these observations that we shall be
particularly concerned and cellular mechanisms will be discussed only if they appear to have clinical
implications. Such an account must necessarily include details of the healing process as it is modified by
contemporary methods of treatment but first it is necessary to consider the events that occur in the
healing of a simple fracture in an(3)

Bone fractures are common and costly to the public due to high health care expenditures. In order to
find ways to treat bone fractures, it is essential to understand how fractures normally heal and what
factors interfere with fracture healing. All fractures can be broadly described as closed (no skin break) or
open (skin break). Fracture of long bones can be classified as simple, comminuted, and stress fractures.
Fracture healing can be considered as a series of four discrete stages occurring in sequence and
overlapping to a certain extent, including inflammatory response, cartilage formation, primary bone
formation, and bone remodeling. This chapter further provides an overview of the fracture healing
process at the cellular and molecular levels and a discussion of several key local factors and systemic
situations that complicate healing processes. Current therapeutic strategies that are aimed at
accelerating fracture repair are also discussed.(4)

This contribution discusses why and how bones break, the stages of fracture healing, and the factors
that influence these processes. The treatment of these fractures is then discussed in detail.(5)
DAFTAR PUSTAKA

1. LaStayo PC, Winters KM, Hardy M. Fracture healing: Bone healing, fracture management, and
current concepts related to the hand. J Hand Ther. 2003;16(2):81–93.

2. Brown SE. How to Speed Fracture Healing. East. 1999;55(4).

3. Kumar G, Narayan B. The biology of fracture healing in long bones. In: Classic Papers in
Orthopaedics. Springer-Verlag London Ltd; 2014. p. 531–3.

4. Arazi M, Canbora MK. Fracture healing. In: Musculoskeletal Research and Basic Science. Springer
International Publishing; 2015. p. 323–41.

5. Auer JA. Principles of fracture treatment. In: Equine Surgery. Elsevier Inc.; 2006. p. 1000–29.