ABSTRACT
BACKGROUND: Fracture fixation and surgical procedures have a very important impact on the final outcome of fracture healing, but the adverse outcome of fracture healing is the result of the combined action of surgical procedures and a series of four-dimensional space events. OBJECTIVE: To explore the four-dimensional space events in fracture healing. METHODS: China National Knowledge Infrastructure and Medline were retrieved, with the key words of “fracture healing, femoral fracture, stress shielding, fracture and blood flow” in Chinese and English. Retrieval of relatively macroscopic factual descriptions corresponds to the four-dimensional space events of fracture healing process, including logically supported and refuted evidence. Combined with literature review, the main four-dimensional space events after fracture fixation were analyzed. RESULTS AND CONCLUSION: The main four-dimensional space events after fracture fixation include blood flow tides, mechanical and biological impulses, grinding disc effect of small gap in hard tissue, stress shielding effect and four-dimensional space drift effect of internal fixation material. Fractures and surgical trauma are accompanied by months of super-compensatory blood flow tides, so there is no ischemia in the macro-level after fracture surgery, but the grinding disc effect will occur in the small gap of hard tissue under unstable condition, resulting in contusion injury and micro-ischemia in the fracture gap. Stress shielding effect caused by too strong fixation is an important reason for refracture after internal fixation removal and bone atrophy and thinning after internal fixation. The small axial drift of plate fixation screw may have important theoretical significance. It has “intelligent” axial dynamic effect, which can make the stress shared by plate gradually decrease with the healing of fracture. Discussing the four-dimensional space events of fracture healing will provide basic logic for the regulation of fracture healing and distraction osteogenesis.