Effects of mechanical factors on the fracture healing process

Clin Orthop Relat Res. 1998 Oct;(355 Suppl):S132-47. doi: 10.1097/00003086-199810001-00015.


An interdisciplinary study based on animal experiments, cell culture studies, and finite element models is presented. In a sheep model, the influence of the osteotomy gap size and interfragmentary motion on the healing success was investigated. Increasing gap sizes delayed the healing process. Increasing movement stimulated callus formation but not tissue quality. Typical distributions of intramembranous bone, endochondral ossification, and connective tissue in the fracture gap are quantified. The comparison of the mechanical data determined by a finite element model with the histologic images allowed the attribution of certain mechanical conditions to the type of tissue differentiation. Intramembranous bone formation was found for strains smaller than approximately 5% and small hydrostatic pressure (< 0.15 MPa). Strains less than 15% and hydrostatic pressure more than 0.15 MPa stimulated endochondral ossification. Larger strains led to connective tissue. Cell culture studies on the influence of strain on osteoblasts supported these findings. Proliferation and transforming growth factor beta production was increased for strains up to 5% but decreased for larger strains. Osteoblasts under larger strains (> 4%) turned away from the principal strain axis and avoided larger deformations. It is hypothesized that gap size and the amount of strain and hydrostatic pressure along the calcified surface in the fracture gap are the fundamental mechanical factors involved in bone healing.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bony Callus / anatomy & histology
  • Bony Callus / physiology
  • Cartilage / physiology
  • Cell Division / physiology
  • Cells, Cultured
  • Connective Tissue / anatomy & histology
  • Disease Models, Animal
  • Finite Element Analysis
  • Fracture Fixation
  • Fracture Healing / physiology*
  • Fractures, Bone / pathology
  • Fractures, Bone / physiopathology
  • Fractures, Bone / surgery
  • Humans
  • Hydrostatic Pressure
  • Metatarsal Bones / injuries
  • Metatarsal Bones / pathology
  • Metatarsal Bones / physiopathology
  • Metatarsal Bones / surgery
  • Movement
  • Osteoblasts / metabolism
  • Osteoblasts / physiology
  • Osteogenesis / physiology
  • Sheep
  • Stress, Mechanical
  • Transforming Growth Factor beta / metabolism


  • Transforming Growth Factor beta