THE PHENOMENA OF EARLY STAGES IN BONE REPAIR

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Abstract
The aim of this paper is to show that the essential principles of bone repair are common to bones in different sites, that the time relationship varies with neither the site nor animal and that there is evidence of a definitive callus which develops on the subcambial surface, on the en-dosteal surface, and on actual faces of the fracture. The observations were made mostly on human fractures with known histories. The principles of bone repair are few and simple; applications are varied. Fragments show erosion and vascularity. At the same time on eroded areas the callus appears, varying in texture, being finely granular in immobile fractures and waxy in mobile. This callus is transformed through successive stages into a cancellous mass and later into tissue with Haversian systems. Inequality of vigor is characteristic of several parts of any fracture. Fragments of bone reduced in vitality but not killed show no activity in repair, but become passively a part of the new structural bone. Actual speed of development of these stages in different areas of fractures is not different. The degree of vascularity may be taken as indication of vigor of bone activity. With vascularity goes a certain amount of erosion. Channels open up in the old bone for the lodgement of vessels and among the eroded spaces new bone grows. Immobile fractures, green-stick, fissured, or spiral incomplete fractures may unite vigorously and quickly despite immobility, whereas mobile fractures take longer or may never unite. En-dosteum is of great importance in bone repair and acts as scaffolding upon which new bone is laid down. Where it is relatively most abundant and where mobility is feeble or absent, repair is quickest.

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