The pathophysiology of fractures: bone healing processes, the role of inflammation and remodeling

the pathophysiology of a bone fracture is a sequence of interrelated events in which the immune response, vascular response, osteogenic cell activity, and mechanical environment form a single regenerative system. The article proposes a holistic healing model that combines the inflammatory phase, the formation of soft and hard callus and later remodeling, as well as their molecular determinants. Based on literature synthesis and conceptual modeling, the temporal profiles of key processes and mediators are visualized, the mechanisms of "coupling" of immunity and osteogenesis, the role of hypoxia, angiogenesis and mechanotransduction are analyzed. The risk factors for impaired consolidation, including aging, diabetes mellitus, nicotine intoxication and pharmacological intervention, as well as the fundamental consequences for the choice of tactics of fixation and dosing of the load, are discussed. It has been shown that the optimal outcome is determined by an early self-limiting inflammatory reaction, a timely transition to chondrogenesis and osteogenesis, and subsequent prolonged remodeling under the influence of functional loads.

bone fracture, healing, inflammation, callus, osteoimmunology, angiogenesis, osteoblasts, osteoclasts, remodeling, mechanotransduction