McKibbin, J Bone Joint Surg Br 1978 - The Biology of Fracture Healing in Long Bones

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The Biology of Fracture Healing in Long Bones

McKibbin·J Bone Joint Surg Br·1978·1,184 citations·Review article

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McKibbin's 1978 review systematically describes the biology of long bone fracture healing, organizing repair into sequential but overlapping phases and identifying three distinct bridging mechanisms — external callus, medullary callus, and primary osteonal union — each governed by different mechanical and biological rules.

Key Findings

Fracture healing is not a single process but a series of overlapping phases, each governed by different mechanical and biological rules:
- inflammation
- primary callus response
- external bridging callus
- late medullary callus
- remodeling A factor that accelerates one phase may suppress another, so no single 'law' of healing holds.
The primary callus response is a once-only burst from predetermined bone-derived cells that cannot be reactivated — if callus collars fail to contact the opposite fragment by ~2 weeks, they involute permanently, making early mechanical alignment biologically time-sensitive
External bridging callus is the fastest route to diaphyseal strength restoration but is suppressed by rigid fixation; it draws its blood supply from surrounding soft tissue, so tissue handling during plating directly determines healing speed
Primary osteonal union demands anatomic reduction and extreme rigidity yet is not faster than callus-mediated healing — radiological gap obliteration under rigid fixation does not signal return to pre-injury strength, so implant removal timing cannot rest on X-ray appearance alone
Cartilage forms in callus where oxygen tension is low, not simply where motion exists — it persists as a bridging material until vascularity catches up, explaining why avascular zones reliably favor chondrogenesis over direct bone formation

Board PearlFractured bone ends are dead and unite not by direct contact but through three separate bridging mechanisms, external callus, medullary callus, and primary bone union.

The Biology of Fracture Healing in Long Bones.

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The Biology of Fracture Healing in Long Bones

McKibbin·J Bone Joint Surg Br·1978·1,184 citations·Review article

|

McKibbin's 1978 review systematically describes the biology of long bone fracture healing, organizing repair into sequential but overlapping phases and identifying three distinct bridging mechanisms — external callus, medullary callus, and primary osteonal union — each governed by different mechanical and biological rules.

Key Findings

Fracture healing is not a single process but a series of overlapping phases, each governed by different mechanical and biological rules:
- inflammation
- primary callus response
- external bridging callus
- late medullary callus
- remodeling A factor that accelerates one phase may suppress another, so no single 'law' of healing holds.
The primary callus response is a once-only burst from predetermined bone-derived cells that cannot be reactivated — if callus collars fail to contact the opposite fragment by ~2 weeks, they involute permanently, making early mechanical alignment biologically time-sensitive
External bridging callus is the fastest route to diaphyseal strength restoration but is suppressed by rigid fixation; it draws its blood supply from surrounding soft tissue, so tissue handling during plating directly determines healing speed
Primary osteonal union demands anatomic reduction and extreme rigidity yet is not faster than callus-mediated healing — radiological gap obliteration under rigid fixation does not signal return to pre-injury strength, so implant removal timing cannot rest on X-ray appearance alone
Cartilage forms in callus where oxygen tension is low, not simply where motion exists — it persists as a bridging material until vascularity catches up, explaining why avascular zones reliably favor chondrogenesis over direct bone formation

Board PearlFractured bone ends are dead and unite not by direct contact but through three separate bridging mechanisms, external callus, medullary callus, and primary bone union.

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