**7.1. Habits disturbing healing of the fracture**

Several habits affect the healing. Entering hundreds of detrimental substances, including highly toxic and carcinogenic ones, smoking impairs the function of progenitor cells, impairs local circulation, and reduces hemoglobin oxygenation disturbing reparative processes [50]. Alcohol was also shown to evoke its negative impact, but in small quantities may be beneficial supporting the fracture energetically and improving its perfusion [51, 52].

angular, rotation or distraction), displacements disrupt the microvasculature that deprives the fracture of blood supply arresting the healing at the phase of cartilage ossification (**Figure 4**). In consequence, the cartilaginous pseudoarthrosis is formed presenting an abundant callus formation, the hypertrophic non-union [53]. It is usually observed in not immobilized frac-

**Figure 4.** Fracture gap and its newly formed vasculature (red lines; a) dislocated by-side (b), rotation (c), angulation (d)

Fracture Repair: Its Pathomechanism and Disturbances http://dx.doi.org/10.5772/intechopen.76252 13

However, rigid fixation precluding movements between bone fragments deprives them of mechanical stimuli that promote osteoblastogenesis [54]. Optimal amplitude of axial movements is below 1 mm, as those are beneficial for osteogenesis, but do not disrupt the blood

It was shown that an excessive distance between bone fragments leads to the cessation of reparative processes leading to non-union [55]. The contact between bone fragments is reduced by a half when translocation reaches 6% of the bone's diameter or five degrees of angulation. Moreover, decreasing cortical thickness that characterizes osteoporotic bone aggravates the loss of interfragmentary contact (**Figure 6a-c**). That leads to the conclusion

tures, but may also occur in stabilized ones due to implant's destruction (**Figure 5**).

that fractures require accurate repositioning, especially osteoporotic ones [56].

supply. Other dislocations are detrimental.

**Figure 5.** Hypertrophic non-union of the non-stabilized fracture.

and controlled axial movements (e).

Several other addictions, including opioids, cannabinoids, and psychostimulants, indirectly influence the healing trajectories degrading the patient's psychosomatic status, and thus resulting in poverty, homelessness, malnourishment, and increased susceptibility to infections and additional injuries. Addicted persons have also limited access to health services, both due to social and economic reasons, and their irrational behavior. Moreover, some of them are not interested in successful treatment at all, as complications, when occur ease them to obtain social support.
