REVIEW Does traumatic brain injury result in accelerated fracture healing? John Morley a , Sarah Marsh a , Emmanuil Drakoulakis a , Hans-Christoph Pape b , Peter V. Giannoudis a, * a Department of Trauma and Orthopaedic Surgery, St. James’s University Hospital, University of Leeds, Beckett Street, Leeds LS9 7TF, UK b Department of Trauma, Hannover Medical School, Hannover, Germany Accepted 27 August 2004 Contents Introduction ................................................................ 364 The physiology of fracture healing.................................................. 364 Inflammatory phase of fracture healing ............................................. 364 Reparative phase ........................................................... 364 Remodelling .............................................................. 364 Factors influencing bone healing ................................................. 364 Hormonal influence on bone healing ............................................... 364 Growth factors and cytokines involved in bone healing ................................... 364 Bone healing after traumatic brain injury ............................................. 365 Accelerated fracture healing .................................................... 365 Potential mechanisms for accelerated bone healing ..................................... 365 Accelerated fracture healing, or purely heterotopic ossification? ............................. 367 Research opporutnities ....................................................... 367 Conclusion ................................................................. 368 References................................................................. 368 Injury, Int. J. Care Injured (2005) 36, 363—368 www.elsevier.com/locate/injury KEYWORDS Brain injury; Fracture healing; Physiological restoration Abstract In patients who have sustained a traumatic brain injury with an associated extremity fracture there is often a clinical perception that the rate of new bone formation around the fracture site is increased. Whether this rapidly forming new bone is fracture callus or a variant of heterotopic ossification, a common complication of traumatic brain injury, is the subject of some debate. This review will provide a comprehensive analysis on this topic and will discuss clinical and physiological evidence as well as potential areas for future research in this field. # 2004 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +44 113 2065298; fax: +44 113 2065156. E-mail address: pgiannoudi@aol.com (P.V. Giannoudis). 0020–1383/$ — see front matter # 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2004.08.028