Bone fractures do not heal the way we thought, experts discover

The presence of fibrin – a protein involved in blood clotting – is not needed for bone healing after all, and actually it is the breakdown of the protein that is essential for fracture repair, says new research in the Journal of Clinical Investigation.

The findings could result in a complete rethink on how fractures heal and change the way healthcare professionals promote fracture repair.
Fibrin is a protein that helps stop bleeding during blood clotting. When bones break, blood vessels do too and fibrin helps stop the bleeding. Fibrin is normally present in an inactive form (fibrinogen). When bleeding occurs, a clotting enzyme converts fibrinogen to fibrin, which forms a mesh of fibres that holds platelets in place to help a clot to form.

Experts previously assumed fibrin helped bones heal by providing a scaffold to support the formation of new bone. But using mice, the new work suggests that bone repair is normal in mice missing fibrinogen.

Many of the current drugs used to promote fracture healing are based on fibrin, and while in some cases this may help, the new study shows we may not need it.

“Bone biology does not require fibrin to heal a fracture,” confirms lead author, Dr Jonathan Schoenecker.

The findings may explain why advanced age, smoking, obesity and diabetes tend to impair fracture repair, as these conditions are all linked with inability to clear fibrin effectively. The team hopes that lowering fibrinogen could help adults heal quickly, like children.

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Image credit: Umberto Salvagnin