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At this early stage, it is crucial that the fragments of bone are guided back into place to ensure that they are correctly aligned and to help stem the loss of blood. A soft callus starts to form, made up of new connective tissue, microscopic blood vessels, cartilage and soft spongy bone.
By 12 weeks after fracture, osteoblasts have transformed the soft callus into a hard callus. The length of the healing period depends on the fracture site — bones in the lower limbs can take longer because they are larger. The healed bone will continue to be remodelled over the coming months and years, in response to stresses imposed by physical activity.
Non-union bone fracture is diagnosed if there is no evidence that the broken bone will heal fully without further medical intervention. As the populations of developed countries age, the incidence of fractures, including non-union bone fractures, will increase. Conventionally, the treatment of non-union bone fracture involves surgery to stabilize the fracture site and bone grafting to stimulate the growth of bone and new blood vessels.
Researchers are now turning to regenerative medicine to help heal such fractures. They aim to deliver a type of mononuclear cell called endothelial progenitor cells EPCs to the fracture site to induce blood-vessel regeneration and promote bone formation.
EPCs express the protein CD34 on their surface, which acts as a marker that enables them to be identified in and extracted from blood. A study 4 by researchers in Japan showed that treatment with CDexpressing cells seems to be safe, and bone fractures healed in all people who received the therapy. But the study was too small to determine any clinical benefit. A larger, three-year trial at several institutions to study the effects of CDbased therapy started in The results should reveal whether regenerative medicine can help to heal broken bones.
This article is part of the Non-union bone fracture Outline, an editorially independent supplement produced with the financial support of third parties. About this content.
Donaldson, L. Community Health 62 , — Buza, J.
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