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The newly formed blood vessels continue to proliferate, allowing further migration of mesenchymal stem cells. Subperiosteally, woven bone continues to be laid down. As a result, the cartilaginous callus is resorbed and begins to calcify. RANK-L is expressed, stimulating further differentiation of chondroblasts, chondroclasts, osteoblasts, and osteoclasts. The cartilaginous callus begins to undergo endochondral ossification. At the same time, adjacent to the periosteal layers, a layer of woven bone is laid down by the osteoprogenitor cells. As a result, chondrogenesis begins to occur, laying down a collagen-rich fibrocartilaginous network spanning the fracture ends, with a surrounding hyaline cartilage sleeve. Further mesenchymal stem cells are recruited to the area and begin to differentiate (driven by BMPs) to fibroblasts, chondroblasts, and osteoblasts. The release of VEGF leads to angiogenesis at the site, and within the hematoma, fibrin-rich granulation tissue begins to develop.
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These cells act together to remove damaged, necrotic tissue and secrete cytokines like vascular endothelial growth factor (VEGF) to stimulate healing at the site.įibrocartilaginous Callus Formation (Days 5 to 11)
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These cytokines act to stimulate essential cellular biology at the site, attracting macrophages, monocytes, and lymphocytes. The injury to bone results in the secretion of pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-α), bone morphogenetic proteins (BMPs), and interleukins (IL-1, IL-6, IL-11, IL-23). The hematoma clots and forms the temporary frame for subsequent healing. The blood vessels supplying the bone and periosteum are ruptured during the fracture, causing a hematoma to form around the fracture site. This stage begins immediately following the fracture. However, these stages have considerable overlap. This process can be broken down into four stages. Located in Irvine, California, IFA has more than $1.83 billion of assets under management, about 1,800 clients, and 40 employees located throughout the country as of March 31, 2013.The mechanism of fracture healing is an intricate and fluent process.
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Securities and Exchange Commission as a fee-only independent financial advisor. Hebner is especially knowledgeable about the research indexes designed by renowned financial economists that provide the building blocks to the passive indexing investment strategy that Hebner recommends. His mission is to change the way the world invests by replacing speculation with education. He accomplishes this through regular webcasts on IFA.tv, articles, and blogs. Hebner is considered a leading authority and provider of investment education. His current and previous Index Funds books received praise from financial industry and academic luminaries, including John Bogle, David Booth, Burton Malkiel, and Nobel Laureates Harry Markowitz and Paul Samuelson. Hebner is the founder and president of Index Funds Advisors, Inc., (IFA), author of Index Funds: The 12-Step Recovery Program for Active Investors, and creator of ifa.com,, and.