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.
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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.