Healing of a fractured bone is quite a complex process but I will try to simplify.
To understand the process better we need to have an idea about the anatomy of the bone. Bone is surrounded by a thin membranous layer of tissue called periosteum ( See adjoining Figure – The figure represents a cut section through a bone. Normally the bone is like a cyllinder. Imagine cyllinder cut into halves along its longitudinal axis and you would get a similar picture. ).
When bone breaks, it bleeds from its torn ends due to disruption of its supplying vessels. Quite naturally the periosteum also is torn as shown in the figure. This periosteum may be completely torn or partially damaged depending upon the force of injury. The collected blood is called fracture hematoma.
Due to loss of vascularity or blood supply adjacent portion of broken ends die. Inflammation changes occur in the haematoma over next few hours ( A reaction by the body which occurs whenever there is an insult to a part or structure. The basic purpose of the inflammation is to contain the damage and facilitate the healing and regeneration. Inflammation is responsible for redness, pain, warmth and tenderness of the wounds and abcesses) .
This inflammation brings in many cells that would help in regeneration of the broken bone. Periosteum plays a vital role in fracture healing. The periosteum is the primary source of precursor cells which develop into chondroblasts( cartilage cells) and osteoblasts ( bone cells) that are essential to the healing of bone. as the time progresses, the fibroblasts ( A kind of cells which produce fibrous tissue in the body) get interspersed with small vesels and form a loose mesh like structure uniting the broken ends of the bone and on which the future layers of bone tissue would be added. this structue is called granulation tissue.
Over the next few days, the cells of the periosteum replicate and transform. The periosteal cells proximal to the fracture gap develop into chondroblasts and form hyaline cartilage. The periosteal cells distal to the fracture gap develop into osteoblasts and form woven bone a kind of bone which is structurally different from the lamellar bone oound in the body.
These two new tissues grow in size until they unite with their counterparts from other pieces of the fracture. This process forms the fracture callus. the callus is the first sign of union visible in x-ray and generally appears around two weeks after fracture. Eventually, the fracture gap is bridged by the cartilage and woven bone, restoring some of its original strength. A picture like this is produced.
From here on slowly and steadily bone is restructured by a process called remodeling.
Hi, my daughter 14 14 months old, she fell whilst trying to walk and immediatley started crying she was taken to AE who sent her home, she was taken back and xrayed where she had fractured her right arm mid length. A cast was applied. Visted follow up appointment cast removed, no xrays bar looking at her arm, prior to the cast she could move her arm etc is this normal practice, do not feel 6 DAYS is long enough to heal a FRACTURE not sure what to do next, PLEASE help.
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:15 pm
@Sarah NEARY,
You are right. Six days is not enough time. Can I see the image.
Would you 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.
Hi please can you advise me in relation to my daughter. My daughter is 14months old she has recently fallen and was taken through to A/E who discharged her without xraying, she was taken back and xrayed where she had 2 fractures to her right arm. The arm was put in to a cast. 6 days later follow up appointment and DR removed cast. 6 DAYS does not appear long enough to heal a fracture, spoke with him who stated that she was moving her arm, however pointed out to him she was moving arm prior to the cast put on and that she is receiving pain relief. I am really not happy about the cast being removed, not sure what to do next PLEASE advise.
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:17 pm
@S Neary,
Please see the previous answer.
Hi, I broke my humerus mid section 6 weeks ago and at the 4 week mark I started doing exercises. I have a humerus brace and tensor bandage for forearm (optional at this point). Now, I’ve been taking the brace off during the day to bath and do exercises and leaving it off during the day. Is this a bad idea? I’m usually sitting down and do minimal walking around. I put it back to sleep and with the tensor.
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:23 pm
@Lee,
If it is being done under the advice of your treating doctor, it could be okay.
Decisions about your arm should come from him/her not some third person.
Hi Dr.
I was reading your article as being interested in knowing more about bone fracture.
I had a severe femur fracture, and under gone surgery inserting a rod through all the bone with two screws at the top another two screws on the bottom side of the bone. Doctors were satisfied with surgery and just asked me to give time for recovery and healing.
It is a little frustrating to know when I can walk again; the x-rays are horrible, the gaps are huge and fracture is scary. Do you think you can have a look at it and estimate a progress time to heal? It is impotant that I know when can I run again.
Accident was also puzzling; I was playing rugby, and broke it while simply running hard, doctors said that my bone is healthy I shouldn’t be worried and I was just unlucky. I can’t believe a hard run would break this particular bone. Can I ask for your advice in email? Your response is very much appreciated!
Dr Arun Pal Singh Reply:
November 9th, 2011 at 5:46 am
@Gilbert,
Would you please ask the query at boneandspine.net. It is our forum and you would be able to upload images as well and It would be easy for me to have a look.
Thank you doctor.
I have registered as Gilbert in boneandspine.net and created and entry ‘femur fracture’
Not sure if you can see it or how to get you to see it.
I hope I get a feedback from you. If there should be another way to do this, please let me know.
Regards
Dr Arun Pal Singh Reply:
November 10th, 2011 at 5:35 am
I have answered your query. You may view and follow it here
http://boneandspine.net/showthread.php?10-Femur-Fracture-Gilbert
MY DAUGHTER FRACTURED HER LEG WHEN SHE WAS ABOUT 18 MONTHS OLD SHE IS NOW 4 YEARS OLD IS IT POSSIBLE THAT THE OLD INJURY CAN STILL SHOW UP AS A FRACTURE ON AN MRI OR CAN IT BE A NEW INJURY OR POSSIBLY THE SAME OLD INJURT THAT NEVER HEALED??
Dr Arun Pal Singh Reply:
November 12th, 2011 at 3:48 am
@SHEREA MALCOLM,
Why MRI? Xray is much better modality. If there is no h/o fresh injury it would be sign of previous injury.
Healing is a rule in children and if the child has no symptoms, I do not think there is a cause for concern for old injury.
BTW, Why was an MRI done?
please help with this surgery had surgery for fractured ulna with plate and 8 screws . one end is healing and the other one is not healing it has been since june the 30 any idea why dr . can’t seem to know . i really am trying to avoid another surgery thanks
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:24 pm
@alice brooks,
I need to see the image.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.
Hello Doctor,
I started playing badminton recently after 12 years and I surely overdid it. Now for last 1 and a half week I have pain (really bad pain) just below my knee and above my ankle. I am unable to walk and climb stairs also. There is too much pain and sometimes it is really unbearable. The knee also seems to be unstable. Please help what it can be and how can it be cured. I am having pain killers.
Regards,
Sam
Dr Arun Pal Singh Reply:
December 17th, 2011 at 6:55 am
@Sam,
Please see a doctor who can examine and advise you in person.
Goodday Dr.
I’ve fractured my femoral shaft 4 consecutive times & dis happened wen i was aged 6-9yrs. I am now 19yrs old. After undergoing several surgeries, i ended up wt bow legs, my left leg is now longer than my right & my left hip is very protruded while my right hip is as straight as a metre rule. Often times i get severe sharp pains in my knees & sometimes in my left hip. Whenever this happens, i find it hard walking. That’s not all, i can’t walk fast,walk or stand for long, run, carry heavy load or do any form of exercise that requires me putting pressure on my legs. My thighs and legs are always fatigued. I don’t limp even though my left leg is longer than my right. I discovered that if i lifted my right leg some few distance from the ground, both hips would be equal. Mind u, my right leg is now shorter & bower than my left. I’m not a doctor but from my own deduction , my right is bower because it touches the ground otherwise i should have a limp. I’ve been to my doctor but i couldn’t get any result.
I know this is very lengthy but please what do you think because i feel very miserable.
Dr Arun Pal Singh Reply:
March 28th, 2012 at 9:02 pm
@Joyce,
Sorry for the delay in replying. There is a lot of information that you are trying to squeeze in few sentences and I am not able to make much.
Would you please elaborate. Never mind the length.
I met with an accident 5 months( i.e., Aug 2011 ) back and i had a compound fracture of right humerus upper middel 1/3 junction. I have undergone orthopeadic surgury by inplanting a rod on the same day.
Even after 5 months it is not healed completly. How long does it take heal completly ???
Dr Arun Pal Singh Reply:
March 28th, 2012 at 9:07 pm
@sagar c,
Can I see your xrays. If it has not united by now it should most likely be non union.
Dear sir,
My right leg tibia and febula was fractured on 6th of january 2012, doctor did surgery on 10th january 2012, he inserted the long rod and two screws, for febula the kept one plate, pls advise me when can i walk, i want to do my professional job quickly
krish…
Dr Arun Pal Singh Reply:
February 14th, 2012 at 7:53 pm
@narender,
The best person to answer this is your treating doctor. But generally speaking if your fibula needed fixation, you would need to keep limb off the ground for average 8-12 weeks.
Hi Dr,
I fractured my mid spine last week, i was only told that it was a verterbra or something like that, i dont know what to do, i was given pain killers and thats it. I feel as though all my pain has gone to my right side of my back and going down my side. I also experience like a nerve or vein pulling in my left temple area and ive also been feeling really light headed and just been making silly mistakes in anything i do now. Do you think this is related to the fall i had that caused the fracture or something else and also i dont know which side to sleep on or how to sit etc. im sorry i know this alot but please can you help me.
Dr Arun Pal Singh Reply:
April 18th, 2012 at 8:34 am
@Jenny,
I do not think my answer would be relevant. It is phenomenally delayed. And I apologize for the delay.
How are things?
Oh and i forgot to mention the doctors said that my rib cage was keeping the fracture stable so im lucky? And how long will it take till i can move around however i want or in other words when will my back fully heal. Thank you so much.
Jenny
My mother is 67 yr old , she slipt in bathroom , she is suffring from back pain we got X – ray one dr. asked to admit my mother for 7 days in his hospital, he said there is fracture in backbone . But i m not bleaving because my mother is walking with some suppport.Pls tell is this possible to walk with some fracture in backbone.
Dr Arun Pal Singh Reply:
March 15th, 2012 at 7:08 am
@PANKAJ,
Not to trust a qualified opinion based on prefixed assumptions may be counterproductive.
You must take another opinion and confirm.
Hi sir my mother got humorous fracture in the month of november2010 and she got operated and a shaft is fixed but no calcus formation after three months of operation when we taken out the xray. then we went for auyurvedic medicine for six month then again we have taken out x ray then only 5 % of calcus growth has seen affter that now i have taken a x ray what it showing i m not able to understand so kind tell what is the position after seeing the xray so how should i must post the xray to u pls reply asap
Dr Arun Pal Singh Reply:
March 14th, 2012 at 6:32 am
@Rishabh,
You can send the xray on contact [at] boneandspine.com
sir, i fell from the scooter 6 months ago and suffered lateral tibial plateu fracture with depression around 4 mm.. also had lcl injury ..did not have any surgery. also had a history of pcl injury 4 yrs ago..i m not able to bend knee more than 90deg ;; also have pain and swelling,almost been on bed for past 6 months.. how long does healing take?. and wat shud i do to recover fast?
Dr Arun Pal Singh Reply:
April 18th, 2012 at 10:47 pm
@sanjana,
I think you need to work on physiotherapy of your knee. Get in touch with your doctor and follow the advice please.
ps- sir i forgot to mention above that i am 26yr old female
sir,
my father had an accident 2 months ago against a truck in eastern ghats.
The accident lead to a seviour fracture in leg and rod has been inserted .
Bt 2 months had passed bt there is nt even a single percent in relief frm pain..
HE IS A SUGAR PATIENT and its becomin vry tough fr him to control d pain..
Lukng at d other posts i thnk u wuld be needed to luk at d xrays n al.. Bt problem is im stayin in hostel n preparng fr forth comng entrance so even i had nt met my dad. Since i am nt in hom so i cnt send u ny xray.
Sir u pls jus
Say dat accordng to u isnt it unhealthy to listen 2 months passed n no betterment..
Can u estimate if everythng is alryte in leg den atleast hw many months it wl tak to recover…
Dr Arun Pal Singh Reply:
April 18th, 2012 at 10:51 pm
@trimod,
It is an unsual thing have the same quantity of pain even after two months following fracture.
Please discuss with your doctor and ask the questions so that you get better answers.
hi Dr Arun. nice to meet you! My dad fell down when he is working on friday which is few days ago. From the x-ray, we found that the T-12 and L-2 fracture. So, doctor in charge recommends putting screws on the T-12 and L-2 (5-6 screws are needed).The recovery will be much faster compared to letting the bone healing on its own. What i concern is the long term side effects after putting the screws? i was informed that he can’t bent down his back after that. may i know to what extend he can’t bend his neck? Will he feel pain or whatever after that? how long will he take for full recovery?
Dr Arun Pal Singh Reply:
April 18th, 2012 at 10:58 pm
@Helen Theng,
There is no relation between the T12-L2 surgery and neck movements. Moreover even the bending of lower back would not affect the daily routine.
Recovery may take from 3-6 months.
what do you think about playing badminton 2 and a half months after breaking my wrist(just above my wrist)? is it a bad idea?
Dr Arun Pal Singh Reply:
March 28th, 2012 at 8:33 pm
@TY,
That would depend on your injury and how it has behaved. Follow what your treating says.
sir i have fractured my fifth metacarpal of right hand. My doctor has applied a plaster/case. Will there be any problem in healing? Is perfomance of normal movement possible after healing?
Dr Arun Pal Singh Reply:
April 18th, 2012 at 11:40 pm
@Jigar patel,
I do not have the required info to answer the query. Please ask the qustions to your treating doctor.