Factors Affecting Fracture Healing

Both local and systemic variables influence the rate and degree of fracture healing. When normal healing occurs, but at a slower rate than usual, it is termed delayed union. A complete cessation of the healing process, in which fibrous tissue is never replaced by bony matrix, is termed nonunion.

Malunited  fracture healing of distal third femur

Oblique Fracture Of Femur United In Malposition

Systemic Factors Affecting Fracture Healing


Young patients heal rapidly and have a remarkable ability to remodel and correct angulation deformities. These abilities decrease once skeletal maturity is reached.

A substantial amount of energy is needed for fracture healing to occur. An adequate metabolic stage with sufficient carbohydrates and protein is necessary.

Systemic Diseases

Diseases like osteoporosis, diabetes, and those causing an immunocompromised state will likely delay healing. Illnesses like Marfan’s syndrome and Ehlers-Danlos syndrome cause abnormal musculoskeletal healing.


Thyroid hormone, growth hormone, calcitonin, and others play significant roles in bone healing. Corticosteroids impede healing through many mechanisms.

Local Variables Affecting Fracture Healing

Type of Bone

Calcellous (spongy) bone fractures are usually more stable, involve greater surface areas, and have a better blood supply than do cortical (compact) bone fractures. Cancellous bone heals faster than cortical bone.

Degree of Trauma

The more extensive the injury to bone and surrounding soft tissue, the poorer the outcome. Mild contusions with local bone trauma will heal easily, whereas severely comminuted injuries with extensive soft tissue damage heal poorly.

Vascular Injury

Inadequate blood supply impairs healing. Especially vulnerable areas are the femoral head, talus, and scaphoid bones.

Degree of Immobilization

The fracture site must be immobilized for vascular ingrowth and bone healing to occur. Repeated disruptions of repair tissue, especially to areas with marginal blood supply or heavy soft tissue damage, will impair healing.

Intraarticular Fractures

These fractures communicate with synovial fluid, which contains collagenases that retard bone healing. Joint movement will cause the fracture fragments to more, further impairing union. When intraarticular fractures are comminuted, the fragments tend to float apart owing to loss of soft tissue support.

Separation of Bone Ends

Normal apposition of fracture fragments is needed for union to occur. Inadequate reduction, excessive traction, or interposition of soft tissue will prevent healing.


Infections cause necrosis and edema, take energy away from the healing process, and may increase the mobility of the fracture site

Local Pathology

Any disease process that weakens the musculoskeletal tissue, like osteoporosis or osteomalacia, may impair union.

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  1. Billy says


    Please i had Tibia and Fibular fractuer since on 7th of July 2008.

    Iwent to a nearby hospital, but callus has not form on the big bone, pls help what drugs can i take to make the bone heal. My age is 25. Thanks looking forward for ur reply.


  2. Dr Arun Pal Singh says


    You did not mention the treatment that you have undergone for your fracture.

    It is quite common for surgically fixed fractures to unite without callus.

    I think it would be beneficial to discuss your queries with your treating doctor.

    Bone would heal on its own if the milieu is right.

    Take care.

  3. Orech Charles says

    1.What are the stages of fracfture healing?

    2.What are the consideration for the choice of fracture immobilozation?


  4. Chad says

    Hello. I am 8 days into a collar bone fracture. My Ortho told me my immobilizer was just for pain control, and I could move my arm – using pain as a guide. Everything I read online is contrary to this – suggesting not moving my arm. I have not had any serious pain, but can sometime feel a soreness in the bone area, and try to adjust myself to minimize.

    I am trying to do research on diet, but also want to check on movement. The bone fracture looks like it over laps, but the ends are not in straight alignment – rather they look to have a 15-20 degree kink in them. Still, over the past few days, my shoulder area is normalizing, as opposed to the huge slouch it had on day 1.

    I also notice my shoulder area is soarest/tightest first thing in the morning, and feels best after cooking a meal using both hands and with some shoulder movement.

    Please advise.

  5. Dr Arun Pal Singh says


    Collar bone or clavicle is known for its unions. Only in very rare cases it fails to unite. Your doctor has rightly advised you. As the pain decreases you can increase the function of the arm. What we advise against is frank movement but within immobilizer movements within limits of pain can be done.

    Kink will not matter when your fracture heals. Even in gross angulations, clavicle and shoulder function is not affected. You seem to making good progress. Have a good intake of calcium rich diet [ I am not advising you supplements] like mmilk, curd or whatever you find appealing.

    Things would get better with time.

    Take care

  6. Anirudh says

    I had ulna and radis break a month back and undergone surgery. Doctor has fixed plates and screws. When should I expect my hand be normal. I am taking calcium rich food regularly.

  7. Dr Arun Pal Singh says


    There is a difference in healing of a fracture and hand becoming normal. I would explain both the concepts to you.

    When we say that fracture has healed it means it no longer requires an additional protection and can be allowed for routine works that do not involve excessive loading of the bone [ That generally means carrying heavy weights and like]

    After the fracture has healed, remodeling of the bone continues and original strength of the bone is regained by a year or so.

    If everything goes well, your fracture should heal between 8-12 weeks.

    You would be able to use your limb in 3-4 months, if nothing untoward happens.

  8. Anirudh says

    Hello Arun,

    First of all thanks for the information.

    After exactly 35 days post-operation, (I had internal fixation as the bone ends are out of line and were overlapping) I am slowly gaining some power in my hands and able to do normal work like taking bath, wearing clothes etc. With each passing day I am seeing progress. However, I am still not able to move my hand in all directions (like putting my palm on neck)

    Doctor has asked not to take weight more than 1 Kg. What I wanted to know was, is it OK to do normal typing work on computer. Also could you please let me know when the plates can be removed generally.

    Any advice on diet?

    Thanks in advance.

  9. Dr Arun Pal Singh says

    Yes! You can type within limits of your pain/tiredness.
    Eat a good protein rich diet.

    If you put on physiotherapy, continue with that. Movements would come back.

  10. Jim says

    Hello. I fracture in my C7 vertebrae. The pain has reduced almost 100% since I was diagnosed (Feb 15). I can do many activties now, but not fully. I'm 28 years old but no bone callus or signs improvement are observed in my X-Rays. What should I do?

  11. Dr Arun Pal Singh says

    Vertebral fractures do not throw callus. They usually take some time to heal.

    I think it should get better with time. Otherwise consult your doctor.

  12. Stacy says

    I am 25 years old, 5'8" and 350LBS. I have a feactured L1 and T7 (in my spine). The T7 aches…but the L1 is the culprit of a lot of my pain and discomfort. It's July 10. I fractured the bones on June 7. They didn't put me in a back brace because of my size. They instead put me into physical therapy. I don't know what the extent of the fractures are. I asked to see but was told the x-rays are kept on the computer system..yadda yadda…So my question is…was it wrong of them not to find me a back brace? I have a vitamin D/Calcium problem. I also have hypothryoidism. I am supposed to start physical therapy in 5 days (as soon as I find someone). Are the odds against this pain going away?

  13. Dr Arun Pal Singh says


    Your treating doctor can guide you the best. I can provide you with generalized information. braces are part of the treatment but they are not necessarily prescribed in every case. The treatment is based on severity and extent of injury and patient profile.

    Vertebral fractures are known to heal well and but can be associated with vague aches and pains for a long time. But again each patient behaves differently.

    There is nothing like odds against….. You would notice yourself if you are improving or not.

    If you have been prescribed physical therapy and you are doubtful. I think it is a good idea to sort the issues out with your treating doctor who not only knows your problem in detail but also has examined you in person.

    I hope that helps.

  14. Lori says

    Hi my son was just diagnosed with at T7 compression fracture (40%). He had x-rays in the emergency, then sent home that night, and asked to come in the next day for a CT.

    We are waiting to see his doctor and he is at home.

    Will healing take place? Will he have to have a brace? What limits will he have with his activities?

    Any info would help…thanks.

  15. Dr Arun Pal Singh says


    Healing is a natural process after imjury until it is hampered by any factor. You did not mention age of your son and whether there is an associated weakness in the limbs.

    Please discuss these questions with your doctor. He/she would be in better postion to guide you.

    If you still want to ask about anything please let me know profile of the person you are asking about

  16. amanda says

    hello i am 31 years old and i have fractured my s2 it is a compound fracture…i have opted out not to wear a brace….is there any thing i can do to make my recovery easier….and are there any activities that i should avoid..IE….walking, jogging,,sex,,,swiming…are any of these activities going to make it worse

  17. Dr Arun Pal Singh says


    I need more information.How long since injury now? Was there an associated injury? What was the severity of the fracture.

    Has your physician asked to restrict your activities.

    S2 injury in isolation is not that common. Whatwas the mode of trauma?

    In any case the best person to talk about all this is the physician that has personally examined you.

    I can provide only general information while can guide you specifically.

  18. Marie says

    Hi, I'm 43 yrs old, female, 125 lbs, not an athlete. Now 7th wk into a right clavicle fracture. 6th wk xray still no callus. Fracture is midshaft with moderate override, about 1.5 cm displacement. Ends are touching. I've been given an ultrasonic bone growth stimulator. I am to return in 4 wks, on the 10th wk. I am getting frustrated and worried. My grip, sensation and strength from the elbow down has been ok from the start. But my shoulder strength is practically gone, I can only lift my shoulder about 45 degrees forward and out to the side, and 20 deg backward. I can do a bicep curl on my injured side, without weights of course. I can reach my other arm across my chest. But I cannot touch my head or slice food on the table unless I stand up. The doctor hasn't recommended any physical therapy but just asked me to do pendulum exercises, which hurt! I am quite healthy and I have been taking 1200 mg calcium with vit. D daily, multivit, fish oil and chondroitin glucosamine, even before my accident (bike fall).

    There has been talk of surgery if I don't show improvement next visit. At this pt, 1 wk after the bone stimulator, there seems to be a bigger bump where the break was and less popping with certain movements (which was frequent before).

    Am I on the right track? Is this common at my age? I am tortured about whether I should go ahead and have surgery now or wait until there's definite signs of nonunion and risk my muscles wasting away and a frozen shoulder.

    Please comment.



  19. Dr Arun Pal Singh says

    Non union of clavicle is very rare but it can happen. more important than presence of callus is the differential motion between the fracture fragments. I fragments are independently movable, the bone has not united yet.

    In case of event of non union, it is up to you if you want to get operated. Most of the patients get good function even with non union of clavicle.

    But if one is not satisfied, surgery is the option to consider.

    In a normal course fracture of clavicle unites within 4-6 weeks. That is true for all adult ages. Children get union even faster.

    i cannot commend on your progress with the information you have provided. You would be better judge of your progress.

    If you keep your shoulder moving, there is little chance of frozen shoulder.

  20. Marie says

    Thanks for the quick reply. I have scheduled appts for a second and third opinion already and am continuing my pendulum and broomstick exercises. I am not sure if the bones are moving but I feel a major tug in the break area when I attempt movements. Looking in the mirror there appears to be no twitching when I move my arm, which was present before. The bump looks bigger and feels more solid, too.

    I am keeping my fingers crossed. But if surgery is needed, so be it.


  21. Ben says

    HI..I'm a 38yr old male, 5'11 180#, and had a tri malleolar fracture of the left leg and ankle on 5/30. I had ORIF surgery on 6/10. Looking at many of your posts, it seems like the average fracture healing time is 8-12 weeks, then perhaps full use of the leg in 3-4 months, and full bone strength in 1 year. I am currently at 20% weight bearing and have started physical therapy 2 weeks ago.

    My doctor says I can not damage the bones because of the fixation, but I worry that doing therapy and putting weight on the bones could cause a malunion. Is it common to put weight on the bones at such an early time before the fracture is fully healed? I do want to recover as fast as possible, but I don't want more surgery to repair a malunion caused by premature overloading. Is it common to have weight bearing on fractures that are only 8 weeks healed?

    Also, the foot remains excessively swollen. It has not gone down much from the day of the initial trauma. No one can explain why it won't go away…they just tell me it 'should have' gone away long ago. Is this an indicator something is wrong in the foot? Tests for DVT in the leg came back OK. What can I do, beside elevation above the heart (which has so far done nothing) to help this?

    Thanks… – Ben

  22. Dr Arun Pal Singh says


    8 weeks is a sufficient time to put weight on the affected limb until advised against it. The purpose of the treatment is to bring the body back to normal as early as possible.

    Swelling of the foot is common phenomenon after these fractures and surgical treatment. This usually occurs due to injury caused by trauma and surgery [Yes! Surgery is also an insult to the body]. It usually goes away but may take some time in some cases.

    Limb elevation, active ankle moving exercises, centripetal massage {with strokes towards heart to facilitate circulation}, active toe moving exercises are the usual measures.

    I hope that helps

  23. Judith Newman says

    I took a bad fall on my elbow getting on to a plane in Rome 9 weeks ago. My arm was totally swollen and black and blue for a few weeks. My X-ray shows an olecranon fracture 50 % join 2 cm displacement. I have no swelling and have regained 95 % movement of my arm and elbow. I wear an elastic band and it is my left arm so I try not to use it very much. Maybe I made the mistake of swimming a lot for 2 weeks after the injury before I knew it was a fracture. I am reluctant to get surgery with a plate as I do no have the time or want the scar or possible removal of the plate. Is there anything I can do to encourage natural healing for hte fracture or is that impossible. I am a senior but very active and have never had a broken bone.,,I am in good shape and slim. It is in the right place now but can't I deal with this isf it gets worse at a later date. I feel fine.

  24. Dr Arun Pal Singh says

    @Judith Newman,

    2cm displacement is quite significant but because already 9 weeks have passed, we need to look at it from today's angle.

    Pain and discomfort does reduce with healing of the tissues.

    Possibly you may have a problem in overhead extension of elbow against gravity.

    Let me know your functional limitations. Is there any?

    Does your fresh xray show any gap?

    Let me know.

  25. jmcknight says

    Hello all. I am new to this post. I was wondering if anyone could offer me any advise on my situation:

    I am a type 1 insulin dependent diabetic. I wear an insulin pump for control. Last Sunday Aug 1, 2009 I fell and broke my left ankle. The exact diagnosis is Trimalleolar Fracture. The orthopedic doctor is recommending that I have surgery to place a plate and screws for stabilization. I am so scared b/c of my health concern. I am affraid of infection and amputation. Do I have to have surgery or can I do something different to heal? If I have to have surgery, is there any advise that you can render to help w/ safe and healthy healing? Thank you for any advice.

  26. Dr Arun Pal Singh says


    It is very common for diabetics to undergo surgery. There is an increased risk of infection especially if the diabetes is old and not controlled.

    Trimalleollar fracture is best served by surgery. Discuss your cocerns with your doctor. He would be able to explain you better.

  27. Mae says

    Dr. Singh ~

    I am a 42-year-old female. A bit overweight (5' 10" and 205#). Generally healthy with only well-controlled hypothyroidism.

    About six months ago, I fell and sustained what appeared to be a simple distal radius fracture, extra-articular, minimally displaced. I was in a cast for four weeks, then in a removable splint/brace for six weeks. The distal radius has healed beautifully, but a stable fracture of the scaphoid waist became apparent on x-rays after the cast came off four weeks after the injury.

    On an MRI at about four months, everything seemed to be doing well. The scaphoid was not completely healed, but looked good. I was allowed out of the splint/brace except at night and allowed to use the arm/hand with some activitiy restrictions. An MRI last week, however, showed that there had not been any additional significant healing in the past two months. My doctor is pushing me to have surgery as it has been more than six months since the injury. I am reluctant to do so. Right now I am back in a hard cast and scheduled for another MRI in four weeks.

    My questions are: Why is this little fracture so resistant to complete healing? And, is surgery my best option at this point?

    Many thanks, Mae

  28. Dr Arun Pal Singh says


    Fracture distal end radius with fracture scaphoid is not a common entity.

    MI is a very sensitive investigation. Studies have suggested that MRI may over diagnose the problem and is not a good modality to find union.

    It is generally used to find any avascular necrosis that can occur in scaphoid fragment or to check blood flow.

    CT is a better investigation to look for union.

    Apart from all this, even if you have non union and it is not symptomatic and does not hamper your professional or personal it can be left as such. it is not symptomatic in all cases.

    You can discuss it with your doctor.

  29. Armlock says

    My 16yo son has an L2 compression fracture. MRI suggests it is at least 8 or so weeks old. No edema, no other bone issues, no nerve issues. Wedging is anterior only and is characterized as "moderate". He has no pain and has been working out without a break. Any idea on how long we can expect it to heal completely? Is it possible/likely that the bone will remodel and gain its height?

  30. Dr Arun Pal Singh says


    A vertebra heels enough within 3 months to allow upright posture and then it gradually strengthens.

    Usually it does not regain its height.

    Was there a significant trauma? If not then it should be investigated why there is a compression because it requires substantial force to cause this injury unless the vertebra is weakened by some process.

    I am not saying it would be but as a rule I investigate for likely causes in case of non traumatic compressions.

    I hope that helps.

  31. Armlock says

    Dr. Singh,

    Thank you for the reply. It is very helpful. I am farely certain the fracture resulted from trauma though I can't specificaly identify it. He wrestles and competes in judo and has taken numerous falls in the process. I appreciate your point, however, and have scheduled an appointment with a physician just to make sure. Are there any particular questions I should ask our doctor?

    Thanks again!

  32. Dr Arun Pal Singh says


    You're welcome.
    One should rule out any disease if maty be causing the compression if a history of trauma is not present.

  33. Nicole says

    Hi – I'm a 30 year old female. I started having mild pain on both shins back in March of this year. I'm a runner, and I assumed shin splints. The pain only manifested when I would press on the bones – it didn't bother me when running, walking or when I was inactive. I finally saw a doctor three weeks ago, and after x-rays and a bone scan, the doctor diagnosed two stress fractures in my left tibia. I actually saw two doctors, one of whom worked for the other. The less senior doctor, who called me after the results of my bone scan came back, told me not only not to run, but not to swim, use the elliptical trainer or bike. I'd already not been running for two weeks, but had been doing those other activities without pain.

    This week I had my followup appointment with the senior doctor, who told me the exact opposite. I explained that there was a race in February I'd been hoping to run, and she said since I was walking/swimming without pain, and since I'd been having these symptoms for a while (and the bone scan wouldn't pinpoint a date of the fractures) that I might as well try running 1/2 a mile this week.

    That would be great, but I've already tried taking three weeks off and slowly returning to running. After running anything over 1.5 miles, the pain in the tibia would gradually return, again just when I put pressure on the bone. At this point, I really just want to recover. When I asked the doctor about that, she said that if I'd said there was a race in July that I wanted to run, she might tell me to take another month off. It seems to me that my recovery will take whatever time it takes regardless of when any race I might want to run is scheduled.

    Any advice? At this point, I'm planning to take the rest of October to recover – no running, just swimming. That will give me six weeks off from running. At that point, I plan on meeting with a physical therapist to establish a schedule for returning to running. I'm just frustrated that I should get such conflicting advice from two doctors who were supposedly working together. Was the first doctor simply overconservative? Was the second doctor too optimistic?

  34. Dr Arun Pal Singh says


    A stress fracture needs rest and heals with that. But return to activity should be gradual and guarded.

    Do not add miles too soon when you resume running after this period of rest.

    A stress fracture usually occurs when body is being overused.

    It might be a god idea to do brisk walk first and then come to running.

    A good treadmill will give less forces than the ground and you may try it first after you resume activity.

    Please let me know how you are making a progress.
    Good luck.

  35. jonah says

    Dear the all knowing Dr. Arun Pal Singh

    I am doing research on bone healing. I have my own experience with fractures and have been blessed, that I did not need surgery and I am now healthy enough to play division 1 soccer. My question is: Does the genetic make-up of a patient play any role in bone healing.

    My guess is that other than diseases like diabeties and Marfans, that patients that have high blood flow and osteoblasts would increase there chances of fully healing the bone.

  36. Dr Arun Pal Singh says


    I am not aware if there are any genetic differences. But there is an individual variation at rate of healing. Whether that is because of external factors or genetic make up is difficult to know.

    May be future would make us wiser.

    Let me know how does your research go.
    All the best.

  37. Mike says


    On October 9th, I tripped while running and broke the 5th metatarsal (mid shaft) of my right foot. It is displaced by 2mm. I was put in a walking boot. I had my most recent X-rays taken 19 days after the break and there was no visual evidence of healing though my foot looks and feels better. My questions are:

    1) If my foot was going to heal properly without surgery, should there have been signs of healing on the X-ray?

    2) I am scheduled to take another X-ray 33 days after the break. Should healing be visible on the X-ray at that time?

    3) I am experiencing calf pain in the same leg as my broken foot that is at times, very painful. Is that normal when one is wearing a walking boot? My calf does not appear to be swollen or warm to touch.

    4) I have been sleeping with the boot on. Would it hurt to occasionally not wear it (so I can get a good night's sleep)?

    Thank you very much in advance for your help.

  38. Pat says

    Dear Dr. Arun,

    I got my left clavicle and right forearm broken, in September 2003, in a bike accident. I underwent ORIF for right forearm; but left clavicle was left as such and no union in all those years. I could do swim, golf etc. but sometimes left shoulder stucks after some physical aggression. Recently my fingers also started getting numbs and pain got increasing in left shoulder. I underwent ORIF of left clavicle in September 2009. My surgeon fixed LCP Anterior Superior Clavicle Plate with 4 screws with an artificial bone graft. Today is end of 7th weeks. My surgeon asked me to revisit after 6 weeks with should AP X-Ray and removed my sling.

    I cannot move my affected left arm to the right shoulder back and overhead. I am allowed to do some pendulum exercises.

    I feel toughness in my shoulder every morning and LOTS OF CLICKING SOUND. Is it normal? Is my broken clavicle under the plate healing OK? Is it adisable to get plate and screws removed after a couple years?

    Pls comment.



  39. Dr Arun Pal Singh says

    1) !9 days may be early in few individuals
    2) Yes
    3)Usually it does not occur. If it is persistent and calf did not suffer injury, get a check up.
    4) You should ask this to your treating doctor. It should not do any harm though in my opinion but your doctor would have final answer for that.

  40. Jamie says

    I am 34 and have a trimalloer fracture of the left ankle plus it shattered the back bone in the ankle as well. Had surgery on 9-25 at this point still alyed up with foot elevated pain still requires pain meds to control. I read that it takes 8-12 weeks if that is so than I am still a feww weeks out. My question is that true and when should i be able to return to my desk job. ( If I have my foot down for more than 30 mintues the pain gets really bad and it turns purple?

  41. Carolyn says

    I have a small, incomplete nondisplaced fracture to the base of my second metatarsal. The fracture occured mid August and I began treatment on October 6th. My foot was not swollen at the time. I went 3 weeks non-weightbearing with a cam walker boot to mostly protect the foot incase I fell. I did not need to wear it to bed or when sitting. I was also given a bone stimulator to wear 10 hours a day. After 3 weeks, my podiatrist allowed me to go back into sneakers because there was no pain when pushing on the bone/manipulating the foot nor was the fracture visible on the x-ray. The fracture was never visible on x-rays though. It was diagnosed with an MRI and the podiatrist admited that I might need a followup MRI to confirm healing. MRI also confirmed that there was no lisfranc damage to the ligaments or dislocation/subluxation. I also had weightbearing x-rays performed. Anyways, I tried going back into my running sneakers but I still felt a sharp pain at the top of my 2nd metatarsal shaft whenever I pushed off my forefoot or if I lean forward. I went back into the boot. The boot helps but I still occasionally feel that sharp pain if I put too much pressure on the forefoot in the boot. How long does it take for a 2nd metatarsal base fracture to heal? I am 25 and have just been diagnosed with osteopenia. Will my healing be slower because I have osteopenia? I have only been walking a week so should I be concerned with that sharp pain? I went to a orthopedic foot & ankle specialist for a 2nd opinion on my treatment and he thought it was ok for me to be walking as well but just to limit my walking (which I have).

  42. ankit says

    hey … i got a fracture on my 5th metacarpal bone and ignored it for 20 days thinking that it was a sprain .

    and i used a crape band aid . i go it checked recently with a doctor and got a caste on for the fracture .

    will there be any problem because of those 20 days or will things be all right

  43. Dr Arun Pal Singh says


    I think you would be better answered by your treating doctor.

    You did not mention what bone is fractured in addition to trimalleolar fracture. That is fracture around ankle too.

    Foot in dependent position shows swelling usually. I cannot get why should it turn purple.

    It is better to get it checked.

  44. Dr Arun Pal Singh says


    How did fracture occur?

    Did you increase your activity or walked/ran an increased distance before the problem arose?

    From your decription it looks like a stress fracture but I need to know.
    Osteopenia should not cause problem but it should be investigated why do yiou have osteopenia at such a young age.

    Please let me know.

  45. Mike Kalaris says

    Thank you Doctor. As a follow up to my question #2 (re-posted below), if there is evidence of bone healing next week (which will be 33 days since I broke the bone), does that necessarily mean that the bone will continue to heal and I will not require surgery? In other words, can the bone begin to heal (which shows up on X-ray) but then not continue to heal fully (the full 2 mm gap healed)?

    2) I am scheduled to take another X-ray 33 days after the break. Should healing be visible on the X-ray at that time?

    Thank you very much. You truly offer a great service.

  46. Carolyn says

    It actually happened while I was sleeping. I was sleeping in a guest bed where the bedding had been tucked in extremly tight all around the bed providing little resistance. I was actually non-weightbearing at the time healing a stress fracture in the femoral neck of the same leg with the foot injury. I had been 4 weeks non-weightbearing at the time and was sleeping on my back. I fell asleep with my foot held dosiflexed back towards me because of the bedding. I'm not sure what happened exactly because I woke up with a sharp, intense cramp like pain at the top of my foot. I usually get charlie horses in my calves so I tried to massage it out like I would with a calf cramp but it just made the pain feel even worse. The pain lasted 5-10 minutes before it subsided and I went back to sleep. I think I might have hyperflexed the foot back. For the remaining 2 weeks on crutches, I noticed a sharp pain whenever I dorsiflexed my foot. Once I started walking again, I had the same sharp pain at the top of my foot that I am feeling now. In the time between diagnosis and the injury, I went hiking once (I rolled my ankle several times on the hike) and was going through physical therapy for my hip (I have a tiny labral tear) so I'm not sure how much additional damage to the foot I did during that time period. The MRI report said it was a 3mm linear low signal focus with moderate bone marrow edema along with a subacute osteochondral injury to the base of the 2nd metatarsal. I am concerned because I still feel this sharp pain if I put pressure on the forefoot and am not sure if it is "normal" or if it means I'm not healing or I am just not ready to walk. I have a few tests scheduled to find out why I have ostopenia. The bloodwork I have done so far has come back normal. I will add that I went from 150 lbs to 110lbs in 2-3 years as a result of going from being completely inactive to very active (long distance running/playing ultimate frisbee/soccer) in such a short period of time. I was also not eating properly to sustain my newly intensely active lifestyle.

  47. Dr Arun Pal Singh says

    @Mike Kalaris,

    2 mm gap should heal on non operative treatment. Yes! the healing should be visible by this time.

    Thanks for the appreciation. :-)

  48. Dr Arun Pal Singh says


    Because you have two fractures probably stress fractures a cause should be looked for. While stress fracture of metatarsal can occur with increased activity, femoral stress fractures usually do not occur that way.

    They usually occur because of some pathology. Do you have stress fractures at any other site.

    One of the things to rule out is calcium metabolic diseases or which might be due to some disease or malnutrition itself.

    in your foot, If it is a stress fracture, it should heal within a reasonable period. If it is not an underlying pathology may be responsible and may be needed to be addressed at the same time.

  49. philip says

    Hi doctor,
    I broke my 4th metacarpal on right hand , while a ride in water park (my hand hit a joint on the peripherey).
    I had no swelling. But x rau showed fracture (long) . I was on casting for 6 weeks.
    Now the casting is removed. Doctor told me that the joint has not sealed completely, however he told me to continue my normal activities ( I work in a software firm) , except lifting weights? he also gave me some calcium supppliments(Supracal) once a day for 2 weeks.
    Why it has not healed after 6 weeks?
    In latest x – ray i could see the break – but doctor told nothing to worry as part of the joints are already joint.
    Is it normal ?
    What precaution should I take – for howmuch time?

  50. Dr Arun Pal Singh says


    Please mail your latest xray. From your description the things are not very clear.

  51. Colleen says

    Hi, Please give me some sound advice. Fractured my right radial head elbow, was but on pain meds, only needed them for 5 days then there was little pain. I will be getting the cast off nov. 25 the day before Thanksgiving which I am happy about. I work at ups as a package handler and looking forward to getting back to work asap.

  52. Mike says

    Dr. Singh,

    The X-ray on my broken 5th metatarsal which I took 35 days post injury showed no signs of healing. Therefore it was determined that I should have surgery to fix the fracture which I did on November 13. My Doctor inserted 3 screws and was satisfied with the surgery. Since then, I have been in a removable boot and have been told to not put any weight on my foot (and I am using crutches).

    1) How long after the surgery should I be able to bear weight (to the point of pain) on the foot?

    2) How long do after the surgery should I be able to resume normal daily living activities (walking etc.?)

    3) How long after the surgery should I be able to begin running again?

    Thank you very much. Happy Thanksgiving.


    I fell on an outstretched right elbow on 28th. last month. It resulted in 1/3 ulna fracture nearer the elbow and was surgically treated with ORIF on the 8th. of this month. After 2 weeks of surgery I am asked not to use any sling at home, but only when I went out. I am asked to try slight movements like turning the palm in rotatory motion which is very difficult, and slowly bending at elbow jt. to make my arm straight. I don't have any pain but slight pain if I move my arm in twisting action.

    I am a 53 yr old lady without any other health complications. Kindly advise as to how long it takes for healing my right elbow and any additional advise to getting back to normal duties. Thanks.

  54. Sreedhar says

    Hi Doc. I'm 42 year healthy male. I had a proximal tibia fracture with a split extending upto middile of the leg and treated with surgery and LCP; i'm into 8th week. Though pain subsided completely and able to move the leg freely, 6th week x-ray showed no union. My doc said healing process has started but advised me against any load bearing activity. Is it common or i'm slow?. Please advise.

  55. eva says

    Had second metatarsal stress fracture after I increased running. I am out of the walking boot cast since september when healing occured. I am finished my physio therapy sessions but I want to know y my underfoot hurts after walking an hour. I have orthortic shoe insert from the PT and they feel gr8. Why does my underfoot hurt?

  56. Dr Arun Pal Singh says


    Thanks for your wishes and I hope that you are improving.

    Everything depends on how you are making your progress and how your treating doctor is planning future course of treatment.

    Time periods are possible but timeline in an individual is not.

    All the best

  57. Dr Arun Pal Singh says

    Did you also have radial head dislocation along with ulna fracture. It is very common in upper end ulna fracture to be associated with radial head dislocation.

    An xray of elbow would reveal if you had one or not.

    Or asking your doctor might help.

  58. Dr Arun Pal Singh says


    Different people behave differently in regards to fracture union.

    Plus the fixation of a fracture alters the way it heals itself, so the radiological signs like caluus may be absent in cases of rigid fixation.

    If your doctors says that healing process has started it is a good sign.

    It does not matter if you are slow or average. The outcome period has a range and within that range it is absolutely normal.

    Good luck.

  59. Dr Arun Pal Singh says


    I cannot say with surety. There can be a concomitant injury or soft tissue might have tightened.

    If your problem persists, please see your treating doctor.

  60. larry Johnson says

    I'm a 46 year old male , I just fractured my foot on 12- 11 2009. 'Im wearing a boot right now. should I try to keep weight off my foot as much as possible since it is a recent fracture.Should i wear the boot all the time, or would it be ok to take it off at for slepping and showering. I have not been to my doctor yet due being out of town working. i will see my doctor in a day or two.

    Thaks for your responce in advance


  61. Dr Arun Pal Singh says

    @larry Johnson,

    I think you should ask this to your treating doctor when you pay a visit.

    your doctor knows the best what you can and cannot do.

  62. Darren says

    Hi Doctor

    My Son of 14 had a double fracture of his ankle one little bone near his ankle joint and the other was the bottom of his fibula playing soccer. he was on cruches for 3 weeks then they found out it was fractured so they put him in a cast for 5 weeks when he had his cast off he could walk the day after with no pain. his cast has been of for 5 weeks when do you think he can go back to soccer he trains 3 times a week in the gym now with no pain .


  63. Dr Arun Pal Singh says


    It would depend upon the progress he makes with physio after the fracture has heals. Different individual take it differently.

    He should start with light practice after a couple of weeks and then increase gradually within the tolerance limit.
    If required a supervision may be sought.

  64. Mike says

    Dr Singh,

    I had surgery to insert three screws to repair my broken 5th metatarsal on November 13th (my last post to this site was Nov 24). Last week at a visit with my Doctor 5 1/2 weeks after the surgery, the X-ray revealed that the bones were properly aligned etc. but that some of the bone above (towards the toes) where the screws were inserted seemed to be "dark" on the X-ray and my Doctor said that meant it was "dying". I was told to walk on my foot (with my boot) as much as I could tolerate because doing so might stimulate bone growth. Prior to last week, I was told to be 100% non-weight bearing and I was. I know that my situation is not common, but have you seen this before? Is it possible or probable that walking on my foot may in fact cause my bone to heal better? I am concerned what would happen should my bone fully "die"?

    Thank you and Happy Holidays.

  65. Dr Arun Pal Singh says


    Talk to your doctor. If there is a dark lesion it should be investigated to find the cause.

    In other words as you said why should bone die?

  66. ishtyaq says

    Dear Dr. Singh
    I need suggestion as i had an accident (bike fall) and broke left clavical 3 weeks back, mid shaft, in contac 8-10 mm overlap. using arm-sling and trying to immobilize the let hand. but in daily carefull movement the broken edge move a little and i m worried due to that i cant fix the fracture point though very carefull movement of body. Am i under right treatment or is it going in the right path?

    How many weeks will be need to have a mal-union can you pls let me know?
    I am very worried.

  67. Dr Arun Pal Singh says


    A clavicular brace+arm sling is adequate immobilization of the fracture of clavicle. You may want to add clavicle brace if it is not there.

    Malunion occurs in quite a number of cases in fracture clavicle but it not of significance as function is not affected much.

  68. ishtyaq says

    Thank you for your advice. So pls update me whether after 6-8 weeks the fracture should join or not? If it does not join what measures should I take.

    It worries me a lot. Can i join to office for only table works.

  69. says

    dr. singh,

    hello and i enjoyed reading these articles, but i have a question for you, i had a seizure on the 20th of nov 09 and somehow broke my left scapula in 4 places as well as my right humerus and a rib. i was then diagnosed with osteopenia(-2.3). with this condition will it itake more time to heal? i am a 40 yr old male that was in good health until a combination of medicines from the veterans hospital caused the seizure. i still cannot move my elbow out away from my body with my hand resting on my stomach. when i look in the mirror and raise my arms, there is a major difference in the shoulders. the va docs seem to think i'm healing, but i know better and i think they're trying to cover for one another. please help me, thanks, travis

  70. Dr Arun Pal Singh says


    Usually it does. You candiscuss with your doctor if it does not unite.

    If it is a non dominant limb which is involved, I think you can join the office.

  71. Dr Arun Pal Singh says

    @travis greene,

    I do not think osteopenia should make much difference in healing.

    Prolonged anti seizure medication can cause osteopenia and you should take precautions to not let it worsen further.

    The difference in the shoulder could be due to muscle wasting that is associated with injury and absence of use of limb following it.

    Scapular fractures usually heal well. So does the rib.

    I cannot comment on the humeral f54acture as level is not mentioned.

  72. Alyson says


    I broke my fib, apparenlty quite high up in 3 places.

    I had ORIF on the 18th Jan, plate, 6 screws and diastasis screw.

    I am concerned as to the damage to the deltoid ligaments, as this is where there was the most swelling and pain following the accident.

    When will my consultant be able to tell me what damage if any have ben done to the ligaments.

    I had just started my Marathon training as well, so am after any tips to speed up the recovery process.


  73. Kandice says

    Almost a year ago I was in a severe car accident and spent four days in the hospital. My right clavicle was fractured in two different places. I ended up losing my insurance and was never able to follow up with my primary care doctor but the last time he did an x-ray of my clavicle he said it was healing fine. Like I said it's been almost a year later but I'm still having pain where my right clavicle is and in my shoulder. I just got on a new insurance and went to an orthopedic specialist and he ordered an MRI of the shoulder. The MRI showed mild supraspinatus tendinopathy, minimal glenohumeral joint effusion, minimal subacromial/subdeltiod bursal effusion, presumed sublabral foramen and oblique fracture of the proximal diaphysis of the clavicle with inferior displacement of 10 mm. Edema is seen involving the fracture and presumed callus formation. The ortho reviewed my report and also took an x-ray of my clavicle. He suggested that I walk everyday with weights and also put me in physical therapy to strenthen my neck, shoulder, and core. He told me to go get a CT scan of the clavicle to get a better view of where I'm hurting and just bring the films to him after my physical therapy. The physical therapy seems to be irritating my shoulder and clavicle. I called the ortho and explained that I was hurting but he just told me to take some Advil which doesn't help. I picked up my CT scan results and it said- Oblique fracture of the medial diaphysis of the right clavicle with anterior and inferior displacement of the distal fracture fragment. No significant callus formation identified concerning for nonunion. Anterior displacement is 8 mm. I was wondering if physical therapy is the best thing for me right now if I still have a fracture. Some of the exercises are painful. I'm just concerned that the wrong treatment is being done.

  74. ikbal singh says


  75. Dr Arun Pal Singh says


    Ligamentous injury would be there if there was no fracture in the other bone.
    Usually they heal with the treatment. Definitive way of outlining the injury is MRI after injury.
    But if your plate and screw are those of stainless steel MRI is out.

    An aggressive physiotherapy after fracture has healed would help you to get to your routine earlier.

  76. Dr Arun Pal Singh says

    @ikbal singh,

    Please avoid using CAPITAL letters. I would answer otherwise too.

    What was the treatment done at that time, especially for unstable fracture.

  77. Greg Turnbull says

    Hello doctor, I am a 47 year old male with no health problems and am quite fit. I fractured my humerus mid-shaft transverse fracture on Dec 29th 2009, exactly 10 weeks ago. After 6 weeks v. little if any bone formation visible on xray. Feb 12th received Exogen bone stimulator which I have been using for 20 minutes each day, today was 25th treatment. However I still feel as if the bone is separated and unstable, is this normal? It still clicks when I move. Doctor said I have to see him 6 weeks after starting bone stimulator.

    I do remember accidentally stretching my arm out (only at the elbow) 3 weeks after the fracture, and the fracture site seemed to be painful for 36 hours.. It swelled up, and although I had stopped taking painkillers and anti-inflammatories only 3 days after the accident, I did take 1 painkiller and 1 anti-inflammatory that night. Could this have interfered with the healing process? Each xray shows less than 1cm gap and bones in same position. I did have xray done 8 days after starting bone stimulator which showed some fuzziness around the broken edges but no opaqueness in the gap between. I am worried 'scarring' might be inhibiting bone formation, scarring which may have been a result of the problem 3 weeks after the accident and during the healing process.

    How long will I have to wait until I feel good results from the Exogen machine, and will iy work?

    Thank you very much,


  78. Greg Turnbull says

    …………….and sorry, forgot to mention that Exogen's fixed hole in my cast wasn't made directly over the fracture site but about 1 inch above. Doctor saw this on immediate post xray but said Exogen would easily cover the area. (true?)

  79. Dr Arun Pal Singh says

    @Greg Turnbull,
    As such the repeat trauma does not appear to be significant and therefore should not affect healing process.

    I am not sure if bone stimulators work but there is no harm in trying.

    You did not mention if you are being treated by cast or you had a surgery.

    And if you had surgery what was the gadget used?

  80. Greg Turnbull says

    Thanks very much, I am being treated by cast – actually just had an xray yesterday which showed significant bone growth on one half of the fracture, with the other half still open with some evidence of slight opacity on some of the xray. Doctor said it would be unlikely that this would only remain half healed, although it is possible?

  81. Dr Arun Pal Singh says

    @Greg Turnbull,

    That is good sign. That suggests bones are uniting. It should unite completely if the callus is visible in both the views in all the cortices.

  82. Daniel S says

    On 3/20/2010 I fractured my 4th metacarpal (cause: blunt trauma). There was mild to moderate displacement of the 2 segments of the diaphysis, without notable rotation. I believe there was some shortening of the digit secondary to the position of the fractured segments of the metacarpal. I got it cast Monday 3/22/2010. I found it odd that the orthopedist's nurse/pa didn't traction out the digit before casting. It would seem that they doomed me to some degree of shortening deformity, and that traction (external, non-surgical) would be optimal. Should I demand they traction it? Or is their approach reasonable and the standard of care for non-operative management?

  83. dany says

    hai, i was trying to find a reference for my 5th metacarpal,shaft frecture.first of all i appreciate and thanks for the help in advice. I am in canada, and on a friday 2 weeks before i got my both 5th metacarpals fractured,was taken to the emergency,they put a plaster cast and then withina week the plastic surgeon called me,and he made a small correction in my right finger as it was not folding straight and then i am placed now ina new cast,the cast is such tat the hand ftrom my elbow down to the palms are casted and my fingers are free,but my 4th and 5th fingers have been buddy taped.

    now my question is

    1. doctor said i will be able to use my hands in 2 weeks and has called for removal of caste next week that is 2 weeks after my last visit. i am curious that ,will a bone heal in 2 weeks?there was one week prior to this 2 weeks but after that only he corrected the bone.

    2.since my fingers are free there is occasional movmts of my fingers ,as i have to do all my stuff,will this affect my healing?

  84. Dr Arun Pal Singh says

    @Daniel S,

    I cannot comment on the treatment without looking at xray.

    Every fracture is different and treatment that you have been given is also done.
    Your treating doctor would be able to tell you better.

  85. Dr Arun Pal Singh says


    1. In 3 weeks fracture becomes sticky enugh to permit mobilization.
    2. It should not affect the healing.

  86. Chanel.s says

    Hi, I just had a question about fractures

    would a young 9 years old child with an oblique fracture of the diaphysis of tibia be able to return to her usual sport activities within the next 3 months?

    Thank you,


  87. Dr Arun Pal Singh says


    It is always difficult to comment on the query when I do not see any picture.

    Inn any case I think it would take slightly more time

  88. Carolyn says

    What is the difference between a stress reaction and a stress fracture? I have a "mild" stress reaction in my femur (mid-shaft) however the only place where I am feeling pain is in my knee. My dr told me that I could walk using a cane but the pain in my knee is worrying me so I have been using my crutches instead.

  89. Dr Arun Pal Singh says


    I am not aware of term stress reaction. Stress fracture is the fracture that occurs when body is subjected to repetitive forces which are more than it can tolerate.

    For example a non jogger starting heavy jogging is prone to get stress fracture.

  90. Steven says

    Hello, I broke my collar bone on a car crash impact from the seat belt about 4 weeks ago. I was told by my doctor as well as an orthopedic that it should heal fine and x rays i throughout the time show displacement but is typical with collarbones.

    My question is of concern.

    The x rays taken today at the orthopedics office show the bone attached to the chest area in an upright angle almost like a ramp, it isn't raised or anything radical, but the tip of the bone where the break occurred is curled up opposed to down like many x rays i've looked at seem to show. Also the other part ofthe bone where the break was is not attached to other part of the bone instead it shows slight connection but mostly displaced. Will this cause damages longterm? Should I seek a second opinion? I'm trying to get into the Air Force and am nervous it isn't healing properly, or was set in place for that matter looking at the x ray.

  91. Carol says

    Hi Dr. Singh,

    13 weeks ago I fractured my right foot. Initial xray found a closed complete mildly displaced fracture at the base of 5th Metatarsal (acute Jones fracture). On the 10th day (from fracture) I had a lower leg fiberglass cast. Six weeks later, before the cast was removed another xray was noted with intraarticular extension and minimal displacement of the fractured fragment. Rehabilitation ensued for almost a month. Finally, I had another foot xray (12th week): there's a union of chipped fracture but the reconstitution is not precisely in place. Visually, the distal tuberosity has left a snip mark that misshapen it. Though I can now wear my 2.5 in heels shoes, at times mild pain hits the fractured site. Is my reconstructed Jones Fx at risk of refracture until the bone has totally regrown?



  92. Dr Arun Pal Singh says


    Usually it does not cause any functional problems and unite well.

    But non union can occur in clavicle too.

    If you want you should get a second opinion. There is no harm.

  93. Meghan says

    Dr Singh,

    My husband suffered a fracture in his fibula about 7 weeks ago in a motorcycle accident. It was a diagonal fracture just above the ankle, but it was not a through-and-through cut. There was also swelling on his foot, presumably due to muscle and ligament injury. His foot, ankle and calf were bound in a soft cast for 1 week and then in a harder cast for 5 weeks. When this cast was removed, he had an x-ray taken. The crack in the bone appeared to be the same as in the x-ray taken at the time of injury (in fact it appears half a millimetre wider). The total width of the crack is maybe 1.5mm at its widest. But he was told that 'calcification' had occurred, and that the rest would take a year to heal. This diagnosis is causing us some concern, since he is experiencing increasing pain at the fracture site with each passing day. This is in spite of wearing a crepe bandage and heat treatments as instructed by the doctor.

    Is this a case of delayed union? He did jar the injury 4 or 5 times while the plaster cast was in place.

    What should he do to ensure he doesn't aggravate the fracture more? And will he need further treatment to join the bone?

    Many thanks,


  94. Dr Arun Pal Singh says


    Until I can have a look at the xrays, it is difficult for me to comment.

  95. Leo says

    Dr Singh,

    I'm just want to know how factor of age can be influencing healing process?

    I hope Dr can help me to explain more detail.

  96. Dr Arun Pal Singh says


    With age the rate of healing slows down. If a child br4eakes the bone, it is almost sure to unite and in lesser time as compared to adult.

    Similarly a young adult has higher chances of healing as compared to elderly person.

    There is no quantitative measure for this as how would the bone healing behave in particular person at a particular age.

    The reason is decrease in regenerative powers as we grow old.

    I hope that helps.

  97. Beth says


    I had foot surgury to correct a bunion (bunion was shaved and the shaft of my first metatarsal broken and re-aligned to correct the angel). My surgury was in the beginning of May, weeks later i was put in a walking black boot but still on crutches, then 1 month later when i went on June 25 (my next appointment) the bone at the shaft of my first metatarsal shifted a bit, Now on July 28 i went to see my doc, and he said its not healed, from what my foot doc says its not worse but its not better well on a day that my foot was not swollen i felt around the shaft of the bone area by my scar and feel a little round bump that moves a bit. Its tender in that area too. I have mentioned it to my doc but he says there is nothing he can do it just needs to heal so he told me take calcium and were looking into a bone stimulator, blah blah…

    basically what I am wondering is is it possible that when the bone shifted a bit back in June so did a screw (I don't even know if he put screws in my foot or pins or anything at all) if i do have screws/or pins is that the bump I'm feeling or is it the corner of the bone that's shifted, that i can feel through the skin that's caused a slight skin discoloration on that spot, and couldn't my doc tell by the x-ray, if so why has he not elaborated any?

    I'm just upset that i fell like I don't know whats happening exactly with my foot…..I looked into a second opinion but everyone wants the records from my current foot doc and I don't want to stir up anything or upset the doc by getting a sec opinion, i just want to know what that bump is and whats happening to the bone at the shaft area…. sigh :(….. what can I do to get it right and ease this uncertainty, if a screw shifted wouldn' t he know, and would he need to fix that, or is it the bone I feel……please any advice, would mean a lot. Thank you for your time.

  98. Dr Arun Pal Singh says


    No body can confirm as to what is that you feel untill one sees you and examines you.

    I think only your treating doctor can answer your questions.

    have a discussion with him.

  99. ramesh says

    i just got fractured in my right hand metacarpal(small finger). doctor adviced it is simple fracture . i am not having any pain. how long will it take to remove the cast in my hand . how long will it take to heal.

    plss advice

  100. Carol says

    Hi Dr. Arun,

    Relative to my Jones Fx, though healed already but a bit out of position. Will bone still regrow and bring back the base of my 5th Metatarsal to its normal shape? From what I read about Jones Fx healing is slower due to poor blood supply in the area, isn't it the tuberosity a spongy bone, thus, healing prognosis is quick?

    Also, when I was given a go signal to go back to my normal activities, I immediately returned to running eager to regain my (leg) muscle strength.Doing so, I still feel superficial pain in the fractured site. Now, though trivial, my injured foot hasn't been the same. My worry is, if I go back to mountain trekking, the pain might resurface despite utmost caution. Could strenuous activity as trekking trigger complications such as: arterial injury, complex regional pain syndrome and unacceptable chronic symptoms?

    Thanks for your kind generosity,


  101. Armlock says

    Can you give me any idea of what the chances are that a 16 yo with open growth plates who has osteochondritis dissecans with a stable lesion of about 1.5 mm X 1.2 mm (no movement into the cartiledge) will heal without surgery?

  102. Dr Arun Pal Singh says


    I am not sure if you are right about blood supply of the area being poor. Where did you read that?

    Do not run or perform strenuous activities untill enough time has passed and these things should be increased in graduated manner.

  103. Carol says

    Dr Arun Pal Singh Reply:

    August 20th, 2010 at 10:39 pm


    I am not sure if you are right about blood supply of the area being poor. Where did you read that?

    Do not run or perform strenuous activities untill enough time has passed and these things should be increased in graduated manner.


    Hi Dr. Arun,

    regarding the low blood supply in the area of Jones fracture, I read it here :

    http://www.foothealthfacts.org/Content.aspx?id=14… and here…
    http://www.podiatrynetwork.com/document_disorders… and here

    thanks a lot for taking time shedding light into my concerns :o)

    God bless.


  104. Dr Arun Pal Singh says


    What is the site of the lesion? Usually they heal well without surgery.

  105. Armlock says

    Thank you, Dr. Singh. It is on his left leg, the lesion is on the anterior medial, femoral condyle.

  106. says

    Dr Arun Pal Singh Reply:

    August 28th, 2010 at 8:27 pm


    Thanks for the resources.

    How are you now?


    You're welcome Dr. Arun :o

    I'm good. Two weeks ago I went on a day hike (minor) climb, on the way down there was a mild stretch at the front of the ankle that sent a quick pain signal other than that nothing bad happened. By Oct. (6th month from injury) I'm pondering if it would be safe then to join a major climb (multi-day) that would involve a great deal of backpacking load in a more strenuous terrain. Tendonitis is the only threat that makes me skeptical to sign up in the said climb.

    For x-ray reference, you might want to check <a> this. Over time, is it possible that the base of my 5th met. will return to its normal shape?

  107. Dr. Raghav Chaudhary says

    hi…i suffered a fracture of the right clavicle 2 weeks ago and underwent figure of eght strapping and a sling. The fracture is healing well as of now. I am also on category 3 ATT for tubercular pleural effusion since the last 3 months. Could you tell me if the ATT is going to affect my fracture healing in any way?

  108. Kathy Powers says

    My 12 year old son fractured his index finger 7 weeks ago. There is no bone growth occuring. What could be the possible reasons? We also had blood work done and his white blood cell count was 3.7, below normal and his mean platlet count was below normal too.

    What could be going on?

  109. Rohit Sinha says


    I am 28 yrs old and i suffered an accident on my bike 3 weeks back and reports showed displaced fragment shaft in the right tibia. The doctor had operated me within 3 hours of my accident and it was a 3 hour surgery where he inserted a rod from my knee till the ankle of the right leg.

    I do not feel any pain in the leg still and also i am able to bend my knee easily. I am using a walker to walk daily and i do exercises told by my physiotherapist daily atleast thrice. Doctor has told that i cannot put pressure till 3 months from surgery. Could you let me know how long will this take to heal and when can i start walking properly.

    Also when will i be able to walk on atleast a stick.


    Rohit Sinha

  110. Dr Arun Pal Singh says

    @Kathy Powers,

    When did this injury occur?

    What was the treatment taken?

    What do you mean by no bone growth?

    Were the counts done again?

  111. Dr Arun Pal Singh says

    @Rohit Sinha,

    I think you are doing fine. Follow up with your doctor periodically who would be able to guide you better on your walking pattern and use of stick.

  112. james says

    I sustained an impacted fracture of the medial neck of the talus 6 weeks ago… it looked like an avulsion on CT, as if someone took a bite out of the medial talar neck. It's not too deep, perhaps 1/4 of the diameter of the neck, and I was treated with a boot since the fracture was "stable", and had very little chance of avn, per my doc.

    I was healing well at 4 weeks… shifting to an ankle brace around the house, using one crutch or a cane, when the physical therapist did an adjustment and acutely reinjured the fracture. She tightly gripped my ankle and her thumb dug into the fracture site while adjusting the location of the tibia and talus. My doc said it was overly aggressive "hands on" treatment but not to worry, it's jut some inflammation and won't cause long term problems with recovery, and recommended ice and rest.
    That was two weeks ago and it's still hurting even when I'm in the boot and gently push off the ball of my foot with two crutches. I'm think I'm doing all the right things… nutrition, rest, etc.

    Does this still sound like inflammation, or would you think that the callus(?) or beginning matrix was actually disrupted… is there a way to tell? Would a bone scan or CT be helpful in guiding treatment at this point?
    I am very concerned about malunion and other Cx.

    For example, should I be icing still, or putting warm compresses on it to promote blood flow even though it could aggravate swelling…
    Any thoughts you have would be greatly appreciated,


  113. says


    I am 21 years old.I am from kerala.I am suffering from pain in my right hand thumb from last 1month.I fell down while i was playing.now the doctor adviced me to use the sling in that thumb.bt i can't give rest to my thumb.Iam a Graphic designer.now i am afraid of this pain.some one wrote their comments ,that we may be do the surgery,if itz not corrected using this Sling.


    Sarath sp

  114. Dr Arun Pal Singh says


    It is very difficult to disrupt a uniting bone after 4 weeks.

    In any case an xray would tell you about the condition and position of bone.

    If the pain persists, AVN should be ruled out.

    Regarding icing or warming – the ice therapy is generally recommended in acute injury to reduce blood flow.

    I think warm packs would soother you but you must first consult your doctor.

  115. Alexander says

    I had a open fracture talus Hawkins III 6 month ago, now the bone is union,but I have necrosis in half of talus on X ray,I walk with one cruch,it is not painful when I walk.I also start do exercises for the ankle mobility.

    What can I do in this situation?can I have chances to revascularizate the talus,after 2 years or something like that? or sooner or later I have to do arthrodesis?

    I really want a opinion. I read a lot of this fracture,and all of them have a bad development like necrosis.I hope it will be ok,just God knows,I don't know .

    Thanck you very much

  116. Dr Arun Pal Singh says


    Once necrosed, the bone would revascularize on its own, if it will.

    The usual time mentioned in the literature is 25 -65 weeks for revascularization.

    It is not necessary that AVN talus is painful and many a patients do well in spite of AVN.

    However till the revascularization occurs, your foot needs to be protected.

    Your physician must have explained that.

    All the best.

  117. Alexander says

    Thank you very very much Dr Arun Pal Singh. I am from Romania. And the doctors haven't to much talus fracture and the don't know how to manage them. I was non-weight bearing 4 months, then I was partiall weight bearing in a walking boot for 1 month and the I was off the cast and the walking boot and start kinetotherapy. My doctor didn't told me how to protect the foot, he told me to start full weight – bearing, but I am scared and I am still in one crutch and walking with partiall weight-bearing on the foot, despite I don't have any pain. Can you told me how to protect the foot and how can I do something for start early revascularization for the talus.I also have a poor mobility in the ankle,sometimes it swelling and it has a purple color,but it don't bother me. Thanck you very much again from all my heart.

  118. Marlene says

    I fell and injured my right hip and I do believe the bursa sac is devoid of fluid for cushioning. the leg is very weak and i have to use a cane. would a cortisone injection into the sac resolve the problem? everyone else that has had the injection says it gives unbelievable relief for years and they can once again walk normal.

  119. Lola says

    Hello Doctor,
    I am a 19 yr old female and suffered a mildly displaced oblique fracture to the fifth metacarpal approximately 5 weeks ago. I was placed in a splint first then a cast. I just wanted a second opinion as to why it was not aligned back to its normal position because now I have a lack of a knuckle and trouble fully making a fist. Here is my x-ray reference:

    [Ed:Info deleted for privacy issues]

    I also recently had my cast removed after being in it for 4 weeks. However my doctor told me there was "minimal callous formation" and it was still moderately tender over the break told me and it was suggested that I get re-casted but I asked for a splint instead. I've read online that most metacarpal fractures are healed after 4-5 weeks. Does this type of fracture take longer to heal or should I be concerned? Thank you for your time.

  120. Dr Arun Pal Singh says


    Revascularisation is a natural process that would occur at its own pace.

    Protection of the foot means not putting the weight on the limb.

    The foot may need to be protected. It can be done by using a boot or a brace. Please avoid activities that produce impact n the foot. Use a stick on the affected side to share your weight.

    All the best.

  121. Dr Arun Pal Singh says


    Some people take longer time than usual. In the given view, your fracture seems in god alignment.

    All the best.

  122. Alexander says

    How long I must protect the foot?Till it appears on the x-ray the revascularization or just a year, since the accident it have past 6 months.

    Thank you for your time,all the best.

  123. Alexander says

    My doctor told me that I was imobilized in the cast a very long period(5 months and 4 days) and he sad it is enough. He told me just to protect the foot with the crutch and to start kinetotherapy (to increase the mobility in the ankle) from 1 month and also 10 sesions of electrotherapy(for the Algoneurodystrophy symptom) .What is your opinion not to wear a boot and just to use a crutch?

    Thank you for your time,all the best.

  124. LES CHADDERTON says

    Hello, in the 1974 i had a climbing accident whilst serving in marines i fell 30ft on to my feet and boke lots of different bones through out my body i was 21 then and very fit, now 57 and struggling.

    i have had 4 (r) ankle joints and now fused

    compound fracture of my (l) tib and fib

    fracture to my (r) radius

    fractured sternom

    compressed fracture of my lower spine

    8 broken ribs

    but after all that its now taking it toll on me, the main problem now is my (l) leg its keeps swelling up around the calf area and becomes solid i get lots of pain with this and dark area apear on my leg and arevery painful to touch,iam also getting lots of pain from a bone in my foot ( cuboid ) i think its called its swollen and very painful.

    would this be connected to my injury all thosr years ago? can you help with this problem

  125. noelia says

    hola io me cai del techo hace 4 meses y me fracture la primera vertebra lumbar mi pregunta es podre hacer ejercicios o correr por que ya me desespero por hacer me estoy volviendo muy pansona jeje gracias doctor cuidece

  126. Dr Arun Pal Singh says


    There is no time frame. It is individualized. You need to protect till it revasularizes.

    If it is does not do so for a year, it most likely would not.

  127. Dr Arun Pal Singh says


    Talus is too damn slow bone. I would take maximum protection.

    But as a patient you need to listen to your doctor. The advice he is giving you is more individualized and relevant.

    I would always speak in generalizations because of the constraints involved.

  128. Alexander says

    This is how my foot look after the accident,and after the operation. I was operated after 5 hours.

    {Ed note:URLs edited for privacy issues}
    Here is an X-ray after 13 weeks and after the second operation in which the doctor take off the pins and inject bone marrow from ilyac crest in the fracture site,because the fracture didn't consolidate after this time.now after 7 months the bone is union but the avn is still present, After what did you see, what is your opinion? Can this big talus avn to revascularizate again in 1 year.
    And if it will not revascularizate ,than talus will colapse and pain will appear and I must to do arthrodesis.
    Excuse me from my insistence but I don't have with nobody to talk. My Doctor don't speak with me. Please understand me. I want to know my real chances.
    If it will not revascularizate can I leave with this avn if talus will not collapse from my rest of my life?
    I really don't know what will happend with me, because I read a lot of article on internet and I think this is not good to me.
    Thanck you very much, and all the best.

  129. Dr Arun Pal Singh says


    You should see a doctor in person and then reach at a diagnosis.

    I can only provide you information on your condition but I cannot diagnose or treat a disease.

  130. Dr Arun Pal Singh says

    @noelia, usted necesita ver a un médico. Su tratamiento y el pronóstico depende del tipo de lesión de su vértebra tiene asociada déficit neuronal

  131. Dr Arun Pal Singh says


    Have you the latest picture?

    Can you send me all the pictures to contact [at] boneandspine [dot] com!

    I would like to know the present situation. You submitted only 3 images and all of them were initial.

  132. Dr Arun Pal Singh says


    Which comment? I answered on today. Is there any more?

    Please let me know.

  133. Alexander says

    I will make a new x-ray after a week and 7 months after the accident. I will send you immediatly,but with this initial x-ray how it is the situation? Excuse me from the last comment in which I sad "where is my commment?", it's a mistacke.

    Thank you for your time.

  134. Alexander says

    This is the x-ray after 12 weeks [URL moderated]
    This is the first x-ray after 7 months [URL moderated]
    This is the second x-ray after 7 months [URL moderated]
    It shows a little revascularization at the last x-ray?
    Is there a sign of little revascularization at the last x-ray?
    Is there a good difference between the x-ray at 12 weeks and the x-ray at 7 months,and not just the union of the bone,and also the sign of revascularization?

    And after you see these x-ray can you tell me some advices,please.

    All the best.

  135. Dr Arun Pal Singh says


    More important is the latest xray. I would wait for that.

    Its okay. Probably there was a delay in answering your comment.

  136. c.p.singh says

    sir,i have fractured on little finger of right hand.docter tie up ball bandage for 11days then he tied my little finger with ring finger for 07 days,after this xrays show no result.please guide me to hill up soon.my age is 44 years.thanks

  137. Traci Tunbridge says

    Hello Doctor,

    My husband is 9 weeks post injury – burst fracture of the T12 no neurological problems, he is still in a significant amount of pain when sitting up or standing, however he has low pain when lying down or walking is this usual? He is walking about 6 miles a day about 5 separate times – do you think it is ok for him to do this.

    How long is it normally before he should be able to sit up for most of the day? He is 45 years old but has a significant gastrointestinal illness that he is trying to deal with as well. Will this slow down the healing?

    I am having a hard time trying to keep him positive, he thinks he is doomed forever now.



  138. Dr Arun Pal Singh says


    No! I cannot see any appreciable revascularisation as for as I can make from these xrays.

    You need to continue the protection of the foot. All the best.

  139. Alexander says

    How much time I must to protect the foot?Till it will be a sign of revascularization?or until a year pass?

    or after a year I can full weight bearing and if it will no pain,and no colapse ,it is ok,if not I have to do arthrodesis?

    What can I do to help revascularization?

    Thanck you very much.

  140. olaniyi taiwo says

    Hello, had a fractured femur(left leg) on oct 9 2010, I did a surgery and a plates and screws were put to hold them together, fell like 4wks after and had the leg angulated.. Its exactly 3months after surgery and I haven't been able to walk.. I am atimes scared 'cos anytime I lift the leg up I feel movements in my leg.. I hope its not going to take a while to heal up..

  141. Dr Arun Pal Singh says


    Can I have a look at the xray.

    You can send them to contact [at] boneandspine [dot] com

  142. Dr Arun Pal Singh says

    @Traci Tunbridge,

    9 weeks is kind of insufficient time for putting load on the spin. All the activities you describe load the spine, with sitting putting the maximum load.

    Burst fracture is quiet severe injury. Body would take enough time to heal.

    Recommended bed rest period is about 12 weeks.

    At this point I can only tell you to wait and watch.

  143. Dr Arun Pal Singh says


    You can wait till one year from injury. If it has not happened by then, most likely it would not.

    Further treatment would depend on your situation at that time.

  144. alexandru says

    What is the worst thing that could happened if it will not revascularizate.

    Thanck you very much

  145. jaime gonzalez says

    i just recently had surgery on my right 4th metacarpal…..all my fingers move ok, except for my 4th i have trouble moving it back…..also my hands are swollen as well, and i can hardly make a fist. I just want to get back to work, and i am afraid my hand will never be the same.

  146. Dr.Rupesh Mehta says

    dear sir,

    i m an ophthalmologist.i fall down before 6wk and my left hand scaphoid is fractured. i keep cast for 6wk but still there is doubt of non union.so i m very much confused that what to do?.here i take opinions from many orthopedics but there is contraversy.

    so please give your expert comment

  147. Dr Arun Pal Singh says


    It can collapse but that would not necessarily mean you would have symptoms.

    Symptoms would vary in different individuals.

  148. Dr Arun Pal Singh says

    Loosing the leg is improbable because of the condition that we are discussing. The treatment would depend on your symptoms from wait and watch to arthrodesis in worst case.

  149. alexandru says

    Today is my birthday, I am 22 years old. If it will not collapse in 3 years it is impossible to happen?

    After how long I could say I got rid of arthrodesis?

    Thank you very much from all my heart because you are talking to me and help me.

    I was afraid that I could lose the foot, but I understand that this is impossible after how much time,after 8 months and 11 days,because the foot has a normal colour,I have no infection and the muscle grow up.

    I hope that talus it will revascularizate, because I have done much sports before and after the accident.

  150. alexandru says

    Dear Dr,

    I would like to thank you from the bottom of my heart for all your help,

    It has helped in many ways,

    I would like to ask you, what would you recomend, as treatment, exercise, nutrition, and body weight

    looking forward for you response

    thank you for everything

  151. alexandru says

    And I also hear a little sound in the ankle when I make dorsiflexion and plantarflexion.Is this arthrosis? Is this a bad thing?It is no pain but it sound a little bit

  152. Andy says

    Dr Singh

    In your opinion does K-wiring accelerate the healing process in a left intra-articular comminuted distal radius and ulna styloid fracture?

    I had my accident the 10th of january, and I'm due to return to the hospital the 15th of february (4 days)

    I don't feel much pain anymore (except that i believe my cast is swelling my hand), but i have read it takes normally 6 weeks for the healing…so my cast will basically be on one week less (and exactly one month after my pinning surgery.

    Nothing i desire more right now than getting my cast and pins off, just worried it might be a bit earlier.

    thanks a lot!

  153. Dr Arun Pal Singh says

    @jaime gonzalez,

    How much time has passed after surgery. Did you undertake physiotherapy exercises?

  154. Dr Arun Pal Singh says

    @Dr.Rupesh Mehta,

    Can I have a look at the xray. Initial and latest.

    Scaphoid fractures need to be in cast for 12 weeks.

  155. Dr Arun Pal Singh says


    K wire or plaster are not for accelerating the bone healing per se. Their function is to immoblize the fractured fragments in optimal position so as they get proper mileu.

    One of the benefits of fixation by implant is early mobilisation of the neighboring joints so as their function is maintained.

    And of course ability to repose displaced fractures.

    But nothing is responsible for acceleration of healing.

    Moreover, there is no hard line for 6 weeks. Generally speaking, the fracture takes between 4-6 weeks to show union but may take longer depending on the site and type of fracture.

    But there is no rigid rule of 6 weeks.

    Your treating doctor would evaluate you before taking any decision.

    I hope that helps.

  156. Brandon says

    I have a burst/compression fracture of T12 from NOV 6th 2010. I have been undergoing physical therapy for about 5 weeks now and saw a lot of improvment with pain. I had a big weekend last weekend becuase I felt so normal. I did a few things around the house, got some trash out of the car including lifting the stroller and putting it in the garage. We went to the beach and I ran around with my 4 year old a little bit. The whole weekend I felt like the fracture never happend. Then Sunday evening came and my back and spine started to get sore. By the time I layed down that night I felt like I had gone back 3 weeks in recovery. It has been a week since then and it is a little better but still very sore. With 3.5 months of recovery time would running around on the beach and lifting a normal sized stroller for about 12 seconds re-fracture my back? The fracture was T-12 with 32% heighth loss. Some doc reports label it as a burst fracture and other ones label it as a compression fracture.

  157. Dr Arun Pal Singh says


    Belated happy birthday.

    Collapse is not sudden. It would occur over time if it does and a collapse does not result in symptoms in all individuals.

    There is lot of difference between structural changes occurring in body and symptoms. There are so many individual variations.

    All the best.

  158. Dr Arun Pal Singh says


    You can have a good diet rish in protein and calcium and try not to gain wait.

    I think you are already under treatment. Consult your doctor for kinds of exercises you can do. This issue cannot be covered on this website, given the constraints of web.

  159. alexandru says

    Dear Dr,

    when I make dorsiflexion and plantarflexion it sound a little bit the ankle. It is a friction on the side of the intern malleolus. 12 hours before it was no little pain and no sound. it is bone on bone,because it sound like bone on bone?

  160. Aminu Ado says

    I appreciate your effort on educating the world on orthopaedics. Thanks, my God bless you all.

  161. Dr Arun Pal Singh says


    It is not very clear from your information as to what has happened.

    And it seems like an acute situation. Please see a doctor.

  162. Dr Arun Pal Singh says


    It is too early to load your spine heavily. Please work on it gradually and be cautious.

  163. Amanda Coetzee says

    My husband dislocated his 4th and 5th metacarpal bones in his right hand on the 26th of Feb 2011. The doctor corrected it without surgery on the 28th and placed his hand in a cast. He is complaining today that all his right fingers are completely numb with pins and needles. Is this okay? Please advise.. Thanks

  164. Andy says

    Thanks a lot for your kind response of my posting from the last Feb 11th, Dr Singh.

    I appreciate a lot you effort of informing us about what to expect from our treatments.

    I had my cast removed that 15th of february, I'm about to complete 6 weeks without the cast in my wrist. It seems that my bone has healed in a position that won't allow much flexion (only 30 degrees). Wrist extension is progressing nicely though. Supination seems to be quite a challenge still, need to push it as much as pain allows to get in back into position. Pronation is nearly there. I wonder, is there any time frame to know when you have completed your healing? At my stage I'm still hoping the range of movement will increase.

    Thanks again and best wishes

  165. mresh fel says

    hallo Dr,

    i was involved in a car accident in fgeb 8th 2011. i broke my femur bone. i did some xrays today 25th mach 2011 and the report says no callous seen. i have a plate running from my hip joint to the kneee. the fracture is at the middle of the bone. my questions are; 1. after how long does callous develop.2. when can i start putting weight on the leg.3. i have noticed that my right leg which has the fracture is abit more swolen than the left is this normal.



  166. Dr Arun Pal Singh says

    @Amanda Coetzee,

    Reply too delayed for your quesion. Sorry! How is he now?

  167. Dr Arun Pal Singh says

    @mresh fel,
    If there is plate that is fixing the two fragments, callus will not form. The bone in this case would unite without callus formation, a mechanism called primary bone healing.

    Provided there is no gap, a femur should have united by now.

    Can I see your xray?

  168. cherlyn says

    hi i have a fracture on my shoulder at the top of the humerous, i have a wide belt around my rib cage anchoring my arm to my body, i have taken off the sling as it is very uncomfortable prob bc its way too big, do you think this is ok? also i have been sleeping in a recliner to speed the process, its been a week since the fracture and am hoping to go back to work on monday, do you think this would be possible, i have to keepmy arm immoblized for 6 weeks ugh!

  169. Hus says

    Hi, I have left foot oblique fibula fracture two months back, it was operated and metal plate was put immediately. after 2 months the recent x-ray still shows the bone is not joined although there is negligble pain and swelling. why is it so?

    Also is it possible that the bone does not join forever?

    I have started partial weight bearing

  170. hus says

    Hello Doc,

    I had Fibula fracture while Ice skating ( 11th Feb 2011 ) I underwent surgery and plate with screws were put. now after 2 months i took xray and the broken fibula is same ( not joint ) as it was when i took my first x ray.

    Although i have negligible pain and swelling. i am putting partial weight on my leg.

    Why is the bone not joint yet I am afraid whenever I see my x ray, plz advice

  171. Ayon Chatterjee says

    I had sustained a comminuted fracture in my right femoral shaft that resulted from a trauma. The accident happenned on 14.3.2010 and I was operated on 15.03.2010 whereby the fracture was fixed with an implant fitted with two interlocking screws. Till date the fracture has not united. Moreover recently the distal screw has broken. I had consulted Dr. M.S.Ghosh of Kolkata, Dr. Prakash Khanchandani of Sri Satya Sai institute of higher medical science, puttaparthi and Dr. Sunderesh D C of Ramiah Medical College, Bangalore and all of them suggested for an operation again with bone grafting as the only solution. Kindly suggest if there is any other way by medicines by which the operation can be avoided and the fracture get united. Presently I am taking Ostium K2 and fosavance.

  172. Sheela says

    Hello Doctor,

    The site is very informative and am glad that people get reply from you for all their queries.


    I have a problem with right leg. 10days back while playing i landed on ground ackwardly, my right leg got twisted. There was pain and swelling near knee and could not able to walk. I was taken to hospital and got x-ray and CT-scan. Doctor said there is a break in tibia, he gave me leg brace and given medicines Dafalgan and Ibuprofen to take daily and also clexane 40mg injection daily. Now i dont have pain so stopped taking Dafalgan, though i feel slight pain some times in a day.

    Am 29 years old, even now am very scared to go hospitals and surgeries..

    My CT scan reports reads as follows,


    Avulsion of the tibial plate as thorns, with a fragment measuring about 1.7X1.9cm hard, almost non-displaced.

    Small anterior drawer, secondary on the divide.

    Minimal fracture of the posterior tibial plateau, with minimal enforcement almost nonexistent 1mm, measuring about 1x1cm.

    Hemarthrosis associated

    Please let me know the injury grade, is it minor or major. If surgery required or not later. How long it takes to walk. Will this fracture have problems during my older days….

    Please advise.

    Thanks a lot.




  173. Dr Arun Pal Singh says

    @Ayon Chatterjee,

    More than a year has passed after your initial surgery and bone has failed to unite. It has gone into non union and till date bone grafting is the reliable solution.

    I think you need to undergo the surgery as suggested to you by various other specialists.

  174. Dr Arun Pal Singh says


    Usually the surgery is not needed for undisplaced fractures. Just keep a watch over it by regular xrays in follow up.

  175. Danny Liu says

    I fell off an industrial work platform and fell twenty feet breaking my femur, just below the hip joint, the diagonal segment, a clean break, now I have a titanium rod attached to my femur, and going into the hip socket, the femur is fused again, not quite solidified, is there anything I can do to get back to normal, I was going to go back to the Army, but I don't see it is possible, since I can't run right now, I plan on making a full recovery, and maybe go to Ranger School, or Airborne School, do you have any advice you can give me?

  176. Dr Arun Pal Singh says

    @Danny Liu,

    Would you please add the timeline!

    If possible, please send an xray to contact [at] boneandspine [dot] com

  177. Olaniyi Taiwo Oluwad says

    Hello Doctor,

    I had an accident last year october and had a fractured femur, went in for a surgery but it didnt go well(rod and pins), i later had another one sometimes in march (know i have a titanium rod from ma hip to my knee).. I have been able to flex the leg but havnt been able to work with it yet.. It would be exactly 3months on july 13… I can only put little weight on it… I feel some little movement on site of fracture when moving… I just to now if i am doing well… I would send my x-ray for you to see..


  178. Dr Arun Pal Singh says

  179. says

    Hi Doctor,

    This is Ayon again. As per your suggestion I went ahead and got my leg operated whereby I got the previous implant (nail in situ with interlocking screws) removed and had plate osteosynthesis and bone grafting. This operation took place at MIOT chennai on 6th June'11. I have been asked not to put full weight on my operated leg for three months from the date of operation. I require to know that how long would it take for the bone to become as it was before the fracture. Presently I am not taking any calcium supplements as nothing of that sort was prescribed.

    You previuos reply was:

    Dr Arun Pal Singh Reply:

    May 13th, 2011 at 8:45 pm

    @Ayon Chatterjee,

    More than a year has passed after your initial surgery and bone has failed to unite. It has gone into non union and till date bone grafting is the reliable solution.

    I think you need to undergo the surgery as suggested to you by various other specialists.

  180. Kamal Pradhan says

    Hello doctor….I have acute synovitis in left hip for which i went for a surgery, however its been a months since I underwent an operation, still I have not recovered and I am unable to walk, How long will it take me to recover,Also, what food or medicines promotes growth of synivial fluid in my hip joint,I am in tracson right now,,,,

    eagerly awaiting for your reply

  181. Dr Arun Pal Singh says

    @Ayon Chatterjee,

    The bone takes around a year to return to prefracture state/strength. However limb is functional sooner. The period before limb becomes functional varies with fracture and bone.

  182. mary says

    81 yrs old with spinal fractures

    I have several fractures L1-2,L2-3,L4-5, L5-S1 also at T12,T11 . plus sacral ala insufficiency fractures

    At my age Ive ruled out surgery,however need to know how long, and if healing of fractures can occur .My injury occurred in feb of 2011

    thank you

  183. Dr Arun Pal Singh says

    @Kamal Pradhan,

    All your questions would be better answered by your treating physician. You have not provided complete info to deduce from.

  184. Kamal Pradhan says

    Dear Doctor, would u kindly tell me what are the information u require.

    I do not have any history of arthritis or any other illness or shock, the pain was all of a sudden, I believe I had a acute infection in the Left hip ,a capsule had formed in the joint for which I went for surgery, Doctor had advised me six weeks bed rest but two months have passed and I have not recovered. The pain in my left hip does not seem to lessen, right now I am getting shocks in the nerves in my left leg. It is very difficult to walk without support.

  185. Dr Arun Pal Singh says

    @Kamal Pradhan,

    @Kamal Pradhan,

    What I mean that your treating physician has full information on you including your examination finding.

    That doctor is best empowered to give you an answer.

  186. Garry says

    Dr. Arun

    I broke my humerus mid shaft in late July 2011. 13 weeks later the OS says its not completely healed but was surprised when he couldnt bend it at the fracture site or even shift it. He then said the xray shows two weeks behind and that clinically its one whole piece. I asked him whats making it one solid piece and he said its callus formation. He wants me to wear the brace for six more weeks. Does callus formation mean it will fully heal by 29 Nov? If not why should i wait until Jan or Feb for surgery. Should I request surgery after 29 Nov appt if not fully healed. My life has been turned upside down now for 13 weeks and in another six weeks I will not be able to cope for another 8 weeks. Please advise as Im ion the verge of a nervous breakdown.

    im going insane. Thank you


  187. becky says

    I had really bad heel pain starting in july 2011 and an mri showed a calcaneous stress fracture. in august i was placed in a hard cast for 6 weeks. after the 6 weeks, my dr told me to gradually go back to walking in a walking boot. not even 4 days of short distance walking, it was unberable to walk on. i go back to my dr and he told me he didnt know what was wrong anymore and suggested i go to a new doctor.

    2 weeks later, i saw a new ortho and he recommeneded another mri..i just got those results and the mri shows the stress fracture is basically the same as it was in the july mri. i havent walked on it in 11 weeks (other than the 3-4 days after being in the cast for 6 weeks).

    why isnt the stress fracture healing?

  188. Dr Arun Pal Singh says


    However desperate we might become, it is not possible to look into future with certainty,

    However, some predictions can be made by looking at present images as doctor has made in your case.

    Callus is formed when bone attempts to unite and it is one of the signs by which clinician judges the situation of fracture.

    Here is an article that would explain about callus
    <a / rel="nofollow"> Fracture Healing

    Some people heal slowly and it appears that you are also one of them. But one good thing is that you have a fracture that is healing.

    Give it some time and situation should be clear.

    We can discuss it further but I require more info from your side.

    Please post your query at Bone And Spine Forum

    You would be able to upload images as well. A registration {free} is required before you could post.

  189. Dr Arun Pal Singh says


    Is it stress fracture! Do you participate in athletics. Stress fractures in calcaneum are known in athletes or people who take up unaccustomed athletic activity.

    Stress fracture should have healed with the intervention.

    Speak to your doctor if we are missing any thing else.

  190. Patrick says

    Hi Dr

    I am 31 years old and I was involved in a car accident on the 30th of April 2012. I had a type 2 frcture of the odontoid peg c1 and c2. My doctor did a screw fixation of the odontoid 7 days later and put me on the neck brace for six weeks. I would like to know what can I do to speed the healing process? If there is any food I should be eating? and what are the associated complications with the screw fixation? Would my neck mobility return to normal?

    Thank you so much doctor.

  191. Dr Arun Pal Singh says


    Nothing per se can speed the healing process but for optimum results you should take diet rich in protein and calcium.

    For other question, you should consult your treating doctor

  192. Devinda says

    Dear Dr,

    I am 28 years old and I was involved in a motor accident on the 19th December 2011. i had a tibia fibula (right leg / middle point) fracture and tibia artery damage. first my doctors operate tibia artery and then put EF application. after 2 month later removed the EF application and applied full POP cast. Then it applied as a half after the one month later. yesterday (14th June 2012) they removed (crack still can see) my POP cast and put tibia brace. but my leg is still pain. doctor, would my leg mobility return to normal, when?

  193. ALABA FOLAHAN says

    Good day doc.

    I had accident 18th May 2012 and in the process had fracture of Distal third of Humerous. I now have cast on the. I want to know if being inside vehicle all the time will contribute to delay in calous formation. Also, will cast work for or surgery going by my nature of fracture.

    Also, am bulky and muscular Person.



  194. Mawuli says

    Hi doctor, I had an accident about 3weeks ago(29th May, 2012) where my left knee was afected with an initial haematoma. An x-ray shows an oblique fracture line of the medial condyle of the tibia .I have been given a full cast up to date. please am somehow scared and need your help. I'm 28years old.

    Thank you.

  195. Dr Arun Pal Singh says


    What does " Being In the vehicle all the time" means.

    You need to know nature of fracture to answer you other question.

    How are you now?

  196. Dr Arun Pal Singh says


    First thing to answer is if your bone has united. Rest should follow.

    has the bone uniited?

  197. Mawuli says

    6/ 7 / 12

    Hi doctor, please I want to know ; will I have my knee back to its normal shape and function?


  198. says

    Hello doc.

    I need your advice, i had a motorcycle wreck 6 months ago and had numerous fractures. They all healed fine except my left humerus. No surgery on it, just a brace for about 16 weeks then the doc said to take it off. Well there is still a lot of motion at the fracture site. The last X-ray had a lot of callous on one side of the bone but none on the other side. The ends and misagaligned a good bit. I was given a exogen bone stimba week ago. Haven't noticed anything yet. 27 yr Old male, non smoker.

    Any info would be greatly appreciated.

  199. Laura McNamer says


    My mother (81) has been in a nursing home for about three years. She is inmobile because of bad hips, knees, and three back surgeries. She also has frequent UTI, I do not know if that has anything to do with her vast confusion or not. (medium to poor health I would say) Two weeks ago she feel out of her bed. I would say she probably feel about 4 feet. She fractured her left humourous bone above the elbow, her left femur by the hip (impacted hip) and her right femur above the knee. The asked if we would want Hospice to come in because her life expentancy is less that 6 months. How do they know that? Now she is on 100 fentinal (sp?) and morphine every six hours 10m, the first three days she was doing great and now she is in like a coma. Please help! Is this the begining of the end? Could she be drugged up?

  200. Dr Arun Pal Singh says


    Six months, no union yet is almost like a non union. Can I have a look at your latest xrays.

  201. Dr Arun Pal Singh says

    @Laura McNamer,

    OK! She has fractures in her three limbs and on medication.

    But we need to understand why is she in coma. Is there any other problem too?

    I am sorry for the delay in the reply.

  202. Karen says

    I have a left spiral femur fracture that I obtained after a fall back on May 7, 2014. It is now Dec 17, 2014 and after having surgery done where a graphite rod and three screws were placed in my femur to hold it together on 5-10-14 as well as seven weeks of PT immediately after surgery I’ve been battling a staph infection ever since surgery, I think it’s MSSA or something like that it’s not MRSA, and the fracture has very little healing in it only on one side of it, and my knee cap is also dislocated and literally on the side of my leg. Why they didn’t fix that originally I have no clue but the Surgeon said I have a nonunion fracture with an Infection.

    I was born without my left ankle foot, but now they are talking about amputation AK to “fix” the problem. I understand that the only way to get rid of the infection completely is to remove the hardware and if it’s not healing then there is nothing to hold the bones together possibly causing more problems but can they not remove the hardware, clean out the bone and try either putting in another rod AFTER cleaning out the bone or use plates to hold the fracture together and putting me on antibiotics immediately following surgery instead of waiting for a couple of weeks as they did originally? Or is this type of situation an automatic amputation situation? After my surgery for a week in a half I asked my then Dr. to put me on antibiotics because I could tell I was developing an infection at the incision site. I have a rare skin disorder Epidermolytic Hyperkeratosis (EHK) a form of Ichthyosis. Anyway, because of the fact the site didn’t look infected to him he refused to give me any antibiotics and wouldn’t listen to me as if I don’t know how my skin reacts. It got worse and worse so I basically popped the area and the second I did it came pouring out. Although it continued to do so, he continued to refuse antibiotics until he got the culture results back. a week and a half later after I had stopped eating during that time because I was too sick to eat, and after throwing a fit he FINALLY started me on an antibiotic.

    But, that was also only after my surgeon took a culture and sent him the report informing him and I both that he’d never seen an infection that was as severe as mine. Only then did he put me on antibiotics even though I’d been asking the whole time and even told him face to face on two different occasions. Now I have to contend with this. Is my question above possible in my situation?

    Question: Can they not remove the hardware, clean out the bone and try either putting in another rod AFTER cleaning out the bone or use plates to hold the fracture together and putting me on antibiotics immediately following surgery instead of waiting for a couple of weeks as they did originally?

    Thank you,

  203. Arun Pal Singh says

    Amputation is the last option to be considered when every other option is not possible or infection is so severe it is endangering the life. Why this decision is being made is best known to your treating doctor. May be it is the only option left.

    What your question mention is also an option but whether it is applicable in your case or not can only be judged by the treating physician. If you think otherwise, you should take a second opinion.

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