Preface

The twenty-first century is witnessing a growing threat to human beings imposed by many sources, namely natural disasters, terrorism and other conflicts, warfare, and transportation accidents; all of which ignite the rise of major trauma incidents worldwide. This phenomen‐ on mandates physicians involved in trauma management to be prepared to evaluate, diag‐ nose, treat, and stabilize patients who have been exposed to some type of traumatic injuries. These injuries comprise a wide array of patients, from those ready to be discharged after a brief evaluation to those hardly viable after resuscitative attempts and life-saving opera‐ tions. The successful management of trauma depends on a working collaboration of emer‐ gency medicine, surgical disciplines, intensive care medicine, and virtually all ancillary services of a hospital to achieve and maintain homeostasis. Although technological advan‐ ces render many resuscitative techniques more easily available in most parts of the world, there is still space to improve trauma care, especially in exsanguination, hemorrhagic shock, heart and major vessel injuries, pelvic and long bone fractures, ultrasound use, blood prod‐ ucts transfusion, and resuscitation in general, which comprise the theme of the book.

This book is intended to increase awareness of the increased toll of major and multiple trau‐ mas and to help individual physicians be prepared for every situation in this context.

### **Ozgur Karcıoglu, M.D., Prof., FEMAT**

Department of Emergency Medicine University of Health Sciences Istanbul Education and Research Hospital Fatih, Istanbul, Turkey

### **Prof. Hakan Topacoglu**

Duzce University Department of Emergency Medicine Konuralp, Duzce, Turkey

**Section 1**

**Fractures and Related injuries**

**Fractures and Related injuries**

**Chapter 1**

**Provisional chapter**

**Fracture Repair: Its Pathomechanism and Disturbances**

Healing of the bone fracture is a biological process that is based on various cell lineages recruited, activated and regulated by molecular mediators, namely chemokines, growth factors, and cytokines, cooperating in a cascade of events aimed to fill the fracture gap with callus. Remodeling of the callus rebuilds the microarchitecture to the mature bone cancellous or compact, depending on the type of the bone that was primarily at the fracture gap. Restitution of the bone continuity requires activation of mesenchymal stem cells that transform into osteoblasts and mature into osteocytes. It is activated and regulated by molecules released from blood platelets from posttraumatic hematoma, traumatized tissues, nerve endings, and inflowing inflammatory cells. The significance of the inflammatory cells in this process is inappreciable, as they eradicate pathogens, remove wound debris, and supply the fracture gap with molecules regulating forthcoming cellular events. They also provide immune regulation of the healing. To proceed uneventfully, healing requires an adequate bone contact and biomechanical environment, proper oxygenation, and nutrition. Unfortunately, up to 15% of bone fractures show some kinds of disturbances that may result in cessation of reparative processes leading to non-union. Factors, responsible for that, are brought to date based on current literature and clinical

**Keywords:** fracture repair, bone fracture, non-union, mechanical, infection, iatrogenic,

Healing of the bone fracture is a biological process that restores its continuity, mechanical properties, and structure. It bases on various cell lineages recruited, activated and regulated by molecular mediators, namely chemokines, growth factors, and cytokines, cooperating in a cascade of events aimed to fill the fracture gap with callus, which later on is remodeled into

mesenchymal stem cells (MSCs), immune control, pharmaceuticals, nutrition

**Fracture Repair: Its Pathomechanism and Disturbances**

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.76252

Grzegorz Szczęsny

Grzegorz Szczęsny

**Abstract**

observations.

**1. Background**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76252

#### **Fracture Repair: Its Pathomechanism and Disturbances Fracture Repair: Its Pathomechanism and Disturbances**

DOI: 10.5772/intechopen.76252

#### Grzegorz Szczęsny Grzegorz Szczęsny

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76252

### **Abstract**

Healing of the bone fracture is a biological process that is based on various cell lineages recruited, activated and regulated by molecular mediators, namely chemokines, growth factors, and cytokines, cooperating in a cascade of events aimed to fill the fracture gap with callus. Remodeling of the callus rebuilds the microarchitecture to the mature bone cancellous or compact, depending on the type of the bone that was primarily at the fracture gap. Restitution of the bone continuity requires activation of mesenchymal stem cells that transform into osteoblasts and mature into osteocytes. It is activated and regulated by molecules released from blood platelets from posttraumatic hematoma, traumatized tissues, nerve endings, and inflowing inflammatory cells. The significance of the inflammatory cells in this process is inappreciable, as they eradicate pathogens, remove wound debris, and supply the fracture gap with molecules regulating forthcoming cellular events. They also provide immune regulation of the healing. To proceed uneventfully, healing requires an adequate bone contact and biomechanical environment, proper oxygenation, and nutrition. Unfortunately, up to 15% of bone fractures show some kinds of disturbances that may result in cessation of reparative processes leading to non-union. Factors, responsible for that, are brought to date based on current literature and clinical observations.

**Keywords:** fracture repair, bone fracture, non-union, mechanical, infection, iatrogenic, mesenchymal stem cells (MSCs), immune control, pharmaceuticals, nutrition
