Abstract
This study focuses on mechanisms which regulate the process of fracture healing. We studied the form and position of the fibrin-blood clots (FBC) in the zone near the fragments among patients with limb fractures: macroscopically (during open surgical operations to reposition bone fragments) and using sonography. We conducted a histological and immuno-histochemical analysis of biopsy material obtained from the zone around the fracture during surgical procedures on 16 patients in 1–18 days after the fracture. We determined that the density of FBC and their form depends on the volume of damage to the periosteum-muscular fascia and the extent of the shift of fragments. In most cases, with a closed fracture, fibrin-blood clots had a spindle-shaped form. Fibrin along the periphery and in the zone between the fragments has a dense structure, and becomes cellular in central zones. The cells surrounded by fibrin partitions contain blood cells and serum. In many places, fibrin partitions had a one-direction orientation position, and the cells were oval-elongated, which indicated hydrostatic pressure in them. Proliferation of mesenchymal cells began in the vital tissues around the FBC, then during reproduction they pentrated to fibrin. Lengthwise axis of the cells was parallel to fibrin partitions. The bone trabeculae which form on the third week after fracture repeated the orientation of the fibrin partitions. It was determined that the vascular endothelial growth factor (VGEF) concentrates in fibrin and remains in it over the first week after the fracture, later it was found in endotheliocytes, fibroblasts and osteoblasts. The process of filling of the cells with around-fracture FBC lasted 12–18 days and during this period, their osteogenic differentiation occurred. Such tempi and orientation of the process is caused by fibrin with a concentration of growth factors in it. Using the results of the study, it could be assumed that the main conditions for osteogenic differentiation of cells are high concentration of VGEF in the fibrin, which initiates neoangiogenesis and internal tension of fibrin partitions. The formation of structured FBC around the ends of the fragments, which contain VGEF should be considered an initial stage of the process of forming of bone regeneration.
Highlights
In traumatology, there has recently been a tendency towards surgical treatment of fractures of limb bones
The periosteum with muscles under the pressure of blood deformed as a membrane, forming a spindle-shaped space filled with blood; II – fibrin-blood clot retained spindle-like shape as a periphery barrier; was limited by muscles, but had a serum with erythrocytes in its central zone (Fig. 2, b); III – periosteum-muscular fascia was damaged, spindle-like shape was absent, fibrin-blood clots were in the form of fragments and were positioned in different places, the blood saturated the surrounding tissues in large areas, the fragments were shifted to full diameter and along the length (Fig. 2, c)
On histological preparation of biopsy material obtained during a surgical operation, in the first 1– 3 days after the trauma, we found fibrin-blood clots represented by a system of fibrin membranes of different density in the zone around the fragments
Summary
There has recently been a tendency towards surgical treatment of fractures of limb bones. This could be related to the intense impact of the powerful industry of preparations for advanced osteosynthesis. Most of them are designed for an open cutaneous approach to the fractured bone, which increase the risk of disrupting the regeneration process and development of pus-necrotic infectious complications. In the conditions of intense development of the industry of preparations for healing fractures, the selection of the approach for fixating the fragments is significantly affected by factors of an economic-commercial character, which can sometimes infringe biological regulations
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