A unified theory of bone healing and nonunion

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorELLIOTT, D. S.
dc.contributor.authorNEWMAN, K. J. H.
dc.contributor.authorFORWARD, D. P.
dc.contributor.authorHAHN, D. M.
dc.contributor.authorOLLIVERE, B.
dc.contributor.authorKOJIMA, K.
dc.contributor.authorHANDLEY, R.
dc.contributor.authorROSSITER, N. D.
dc.contributor.authorWIXTED, J. J.
dc.contributor.authorSMITH, R. M.
dc.contributor.authorMORAN, C. G.
dc.date.accessioned2016-10-17T16:46:05Z
dc.date.available2016-10-17T16:46:05Z
dc.date.issued2016
dc.description.abstractThis article presents a unified clinical theory that links established facts about the physiology of bone and homeostasis, with those involved in the healing of fractures and the development of nonunion. The key to this theory is the concept that the tissue that forms in and around a fracture should be considered a specific functional entity. This 'bone-healing unit' produces a physiological response to its biological and mechanical environment, which leads to the normal healing of bone. This tissue responds to mechanical forces and functions according to Wolff's law, Perren's strain theory and Frost's concept of the ""mechanostat"". In response to the local mechanical environment, the bone-healing unit normally changes with time, producing different tissues that can tolerate various levels of strain. The normal result is the formation of bone that bridges the fracture-healing by callus. Nonunion occurs when the bone-healing unit fails either due to mechanical or biological problems or a combination of both. In clinical practice, the majority of nonunions are due to mechanical problems with instability, resulting in too much strain at the fracture site. In most nonunions, there is an intact bone-healing unit. We suggest that this maintains its biological potential to heal, but fails to function due to the mechanical conditions. The theory predicts the healing pattern of multifragmentary fractures and the observed morphological characteristics of different nonunions. It suggests that the majority of nonunions will heal if the correct mechanical environment is produced by surgery, without the need for biological adjuncts such as autologous bone graft.
dc.description.indexMEDLINE
dc.identifier.citationBONE & JOINT JOURNAL, v.98B, n.7, p.884-891, 2016
dc.identifier.doi10.1302/0301-620X.98B7.36061
dc.identifier.issn2049-4394
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/16475
dc.language.isoeng
dc.publisherBRITISH EDITORIAL SOC BONE JOINT SURGERY
dc.relation.ispartofBone & Joint Journal
dc.rightsrestrictedAccess
dc.rights.holderCopyright BRITISH EDITORIAL SOC BONE JOINT SURGERY
dc.subject.otherinternal-fixation
dc.subject.otherfracture
dc.subject.othermechanobiology
dc.subject.othercomplications
dc.subject.otherstability
dc.subject.othermodel
dc.subject.wosOrthopedics
dc.subject.wosSurgery
dc.titleA unified theory of bone healing and nonunion
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryInglaterra
hcfmusp.affiliation.countryisogb
hcfmusp.affiliation.countryisous
hcfmusp.author.externalELLIOTT, D. S.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Ashford & St Peters Hosp NHS Fdn Trust, Guildford Rd, Chertsey KT160PZ, Surrey, England
hcfmusp.author.externalNEWMAN, K. J. H.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Ashford & St Peters Hosp NHS Fdn Trust, Guildford Rd, Chertsey KT160PZ, Surrey, England
hcfmusp.author.externalFORWARD, D. P.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Nottingham Univ Hosp NHS Trust, Nottingham NG7 2UH, England
hcfmusp.author.externalHAHN, D. M.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Nottingham Univ Hosp NHS Trust, Nottingham NG7 2UH, England
hcfmusp.author.externalOLLIVERE, B.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Nottingham Univ Hosp NHS Trust, Nottingham NG7 2UH, England
hcfmusp.author.externalHANDLEY, R.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; John Radcliffe Hosp, Oxford OX3 9DU, England
hcfmusp.author.externalROSSITER, N. D.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Basingstoke & Northamptonshire Hosp, Basingstoke RG24 9NA, Hants, England
hcfmusp.author.externalWIXTED, J. J.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Beth Israel Hosp, Boston, MA USA
hcfmusp.author.externalSMITH, R. M.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Massachusetts Gen Hosp, Boston, MA 02114 USA
hcfmusp.author.externalMORAN, C. G.:Univ Nottingham Hosp, Dept Trauma & Orthopaed, Nottingham, England; Nottingham Univ Hosp NHS Trust, Trauma, Nottingham NG7 2UH, England; Nottingham Univ Hosp NHS Trust, Orthopaed Trauma Surg, Nottingham NG7 2UH, England
hcfmusp.citation.scopus116
hcfmusp.contributor.author-fmusphcKODI EDSON KOJIMA
hcfmusp.description.beginpage884
hcfmusp.description.endpage891
hcfmusp.description.issue7
hcfmusp.description.volume98B
hcfmusp.origemWOS
hcfmusp.origem.pubmed27365465
hcfmusp.origem.scopus2-s2.0-85016945847
hcfmusp.origem.wosWOS:000379241400004
hcfmusp.publisher.cityLONDON
hcfmusp.publisher.countryENGLAND
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