A unified theory of bone healing and nonunion

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art_ELLIOTT_A_unified_theory_of_bone_healing_and_nonunion_2016.PDF (1.93 MB)
Citações na Scopus
114
Tipo de produção
article
Data de publicação
2016
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BRITISH EDITORIAL SOC BONE JOINT SURGERY
Autores
ELLIOTT, D. S.
NEWMAN, K. J. H.
FORWARD, D. P.
HAHN, D. M.
OLLIVERE, B.
HANDLEY, R.
ROSSITER, N. D.
WIXTED, J. J.
SMITH, R. M.
Citação
BONE & JOINT JOURNAL, v.98B, n.7, p.884-891, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
This 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.
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URI
https://observatorio.fm.usp.br/handle/OPI/16475
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Coleções
Artigos e Materiais de Revistas Científicas - HC/IOT
Artigos e Materiais de Revistas Científicas - LIM/41