A general theory for the role of intermittently imposed stresses in the differentiation of mesenchymal tissue is presented and then applied to the process of fracture healing. Two-dimensional finite element models of a healing osteotomy in a long bone were generated and the stress distributions were calculated throughout the early callus tissue under various loading conditions. These calculations were used in formulating theoretical predictions of tissue differentiation that were consistent with the biochemical and morphological observations of previous investigators. The results suggest that intermittent hydrostatic (dilatational) stresses may play an important role in influencing revascularization and tissue differentiation and determining the morphological patterns of initial fracture healing.

The progressive ossification pattern in a fracture callus was predicted based on a theory that relates the local stimulus for ossification to the tissue mechanical loading history. Two-dimensional finite element analyses of a fracture callus were considered at three different stages of ossification. The sites of callus ossification represented in the initial model were predicted by previous analyses relating mechanical stress and vascularity to the differentiation of mesenchymal tissue in the early callus. The zones of further ossification, bone bridging, and bone consolidation predicted in the present study were found to be similar to the ossification patterns that have been documented by other researchers. The approach used to predict fracture healing is identical to that of previous studies predicting joint morphogenesis, with the exception that fracture healing requires continuous, attached skeletal elements, whereas joint morphogenesis requires discontinuous, articulating skeletal elements.