Fracture Healing and its Disturbances. A Literature Review.

The healing of a bone fracture is a biological process depending on the activation of mesenchymal progenitors, their accumulation in the fracture gap, proliferation and differentiation into the osteoblastic cell lineage. Its aim is to form a callus in the fracture gap which is later remodelled into mature bone, restoring the mechanical properties lost in consequence of the fracture. Disturbances in fracture repair occur relatively often, causing therapeutic problems and increasing costs of treatment. They are caused by the lack of or damage to progenitor cells, disturbances in molecular regulation of their activation, homing, proliferation and differentiation into the osteoblastic cell lineage, or lack of appropriate environment for their optimal metabolism for fracture repair. This paper discusses the roles of individual factors crucial for the reparative process as well as the mechanisms responsible for their disturbances.