Secondary bone healing (indirect/callus healing) is characterised by which sequence of stages in the correct order?

• A Haematoma → soft callus → hard callus → remodelling
• B Inflammatory → fibrocartilaginous → bony callus → remodelling
• C Reactive phase (haematoma, inflammation) → reparative phase (soft callus, hard callus) → remodelling phase ✓
• D Direct lamellar bridging across the fracture site without callus formation

Explanation

Secondary (indirect) fracture healing proceeds through three main phases: the reactive phase (haematoma formation, inflammatory mediator release, angiogenesis) within days 1–5; the reparative phase (soft callus: mesenchymal differentiation to fibrocartilage, hard callus: endochondral ossification converting fibrocartilage to woven bone) over weeks; and the remodelling phase (woven bone replaced by lamellar bone along Wolff's law stress lines) over months to years. Option D describes primary (direct) cortical healing requiring rigid stability and no callus.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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