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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I also have swelling on the the foot since last 2 months. Do I have to do something for that?
Dr Arun Pal Singh Reply:
March 24th, 2010 at 11:51 pm
@kishore,
This should go. If it is large, then consult with your doctor.
hello doc i posted once before but it was removed i am not sure why, my problem is i broke my humureus mid shaft clean break no bones peircced through the skin, the doc put me in a u slab for 1 week and i have been in a humureus brace for 3 weeks, last x ray was at week 2 which showed good allignment doc was very happy and said i would be able take brace off in further 4 weeks, where my problem lies is that i do not have any control over my right arm, i can move my fingers, wrist and write feel everything along my forearm can rotate my shoulder but i can not move my arm up or down or let my arm rest without a sling as i feel a great sensation of pain near my bicep and elbow, could you please tell me if its normal and when will i gain sufficient control of my arm. thanks in advance
Dr Arun Pal Singh Reply:
March 24th, 2010 at 7:49 pm
@Imran,
A fracture takes around 6-8 weeks to heal. Following that you would need to work out with physiotherapy.
Probably another 15 days.
Good luck
Hi – I have a spiral fracture of the upper humerus. It has been 8 weeks since the injury. I was x-rayed after 7 weeks & the bone is aligned; however it is not showing signs of forming union. Does it need surgery to heal? I have been told that they will x-ray me again in 4 weeks as “there is no point in x-raying me sooner”. How long will it yake before they decide to try surgery.
Dr Arun Pal Singh Reply:
July 5th, 2010 at 12:37 pm
@Deb,
I think they would make decision next week. If bone has not attempted to unite till now, it is less likely.
Have a word with your treating doctor when you meet him next time.
hello, i got 5th metarsal rt foot fracture on march 27, 2010 and was casted on 6th april for 1 month. I consulted Dr. for healing, he said healing is ok. But still i m having swelling on rt. foot while walking / sitting. Pl. advise
Dr Arun Pal Singh Reply:
July 5th, 2010 at 12:44 pm
@sukhjinder singh,
Swelling is different from bone healing and can continue for a period even after union.
It would go with time.
Had a compression plate installed on my left humerus in Jan after a midshaft displaced fracture in Nov. Am thinking I might want it removed if I’m still aware/bothered by the sensation of the hardware next Jan or so.
1. Is the removal of the plate and its 6 screws much simpler/safer than the initial install?
2. Is the chance of a re-break any more or less likely after removal? Intuitively, I thought that the plate gives additional protection from that, but now I’m not so sure. Both ends of the plate seem to form a pair of fulcrums that could increase the chance of new breaks at those points.
I’m a fairly active 66 year old who engages in manual labor like mowing, weed-eating, fencepost driving and tractoring, so I’m subjecting the arm to some fairly jolting, jarring activity.
Dr Arun Pal Singh Reply:
July 16th, 2010 at 8:15 am
@Bill Stacy,
1. It is almost a surgery of same magnitude though the duration would be shorter.
2 Yes! You would need to be in plaster for 6 weeks after removal. The screws removed would leave holes which weakens the bone. Hence the protection.
I hope that helps.
broke upper humerous clean 3 weeks ago. Is on and off pain normal,? Is there stability in the boes already as currently there is no displacement and wonder how easy they could become displaced? I worry it could shift while sleeping or walking but this might seem crazy? Also, is swelling still to be expected in my forearm?
Thanks
Dr Arun Pal Singh Reply:
July 16th, 2010 at 8:32 am
@james bartsch,
Too many questions but little information to help me to deduce an answer.
What is your age?
What treatment has been given?
What is level of the fracture?
i Thought i should leave a little update if you scroll to the top you will see i broke my humerus mid shift clean break, my docs decided on self healing so i had a u slab with a compression brace.
I just wanted people to know it was a long recovery and still going on. initially i couldn’t move my arm for 7 weeks, i tried many times but my arm wouldn’t function little by little and i mean little i started moving my arm here after, baby steps weeks 8 -12 really week grip. 12 – 16 more free movement coming back but still find it difficult to lift stuff which weights a fear amount should be seeing my doc for final x rays to see how its mended. I personally think i have another 4 weeks before i can start some sort of proper exercise on it, but only on docs advice. i hope this helps anyone as i was worried reading horror stories about people not gaining any sort of arm movements or sensations for 6 months
37 yr old male, broke humerous just below shoulder, is not displaced, clean break. Have been in collar and cuff sling last 2 weeks, first 2 weeks u-slab sling. Just had xray, one day shy of 4 week mark, no calus showing yet. Should I be worried about non union and surgery or does it just take a few more weeks to show progress? Also do you have any nutrion tips to speed healing. I was a smoker but heard it hindered bone growth so quit 2 weeks ago, one positive from the fracture.
Thanks
Dr Arun Pal Singh Reply:
July 28th, 2010 at 4:48 pm
@James,
Give your fracture some more time.
Hi !!! I am wondering — how fast can a hairline fracture near the base of the fifth proxima phalanx takes to heal ?? I am asking under general condition with no stress added to it. Also do I need a big cast to wear??? I appled heat treatment on –at the very moment of the impact and Hirudroid cream that worked marvellously. The swelling and pain gone within 2 days and I sought a GP advise. He refer me to an Orthopaedic doctor for next Monday appointment and I am posting to you now during the weekend.
Dr Arun Pal Singh Reply:
August 2nd, 2010 at 3:11 pm
@Melanie,
On an average four weeks. An immobilsation is advised. It may not be in form of plaster but it is advised.
All the best.
Hi I broke my right fibula bone (lower leg) on June 20th 2010. It was a clean break with no surgery required. I was in a splint for 10 days and than a cast for 6 weeks. My cast was removed on Wed August 4th. The doctor said that my bone is not fully healed and i should only walk lightly (no jogging) on it for the next 3 weeks until my follow up appointment. It still hurts and I have a burning sensation at night. Is this common to let someone with a broken bone to walk on it with no cast? Is it possible to delay healing or cause more injury within these next 3 weeks? What if my bone is not healed in the next 3 weeks? Will they put another cast on?
Any reassurance will be much appreciated.
Thanks
Dr Arun Pal Singh Reply:
August 13th, 2010 at 3:50 pm
@Anna G,
If your bone has healed enough to take the cast out, I do not think you can injure it with your routine activity.
And if it is healing, it should further heal with time.
Let me know.
Hi Doctor,
I fractured my fifth metatarsal on my left foot. I’m in an aircast as of now, and I have a boot that i put on when I go to sleep. I’ve noticed that after two weeks, I have a weird, painful sensation where the fracture is. I can’t describe it, but it’s just a quick jolt when I move my foot in a weird position in the cast.
Is this normal during a fracture heal?
Dr Arun Pal Singh Reply:
August 13th, 2010 at 3:52 pm
@Robert Y,
A cast annot give you 1000% immobilization. Therefore it is advisable not to put your foot in weird position.
Whenever you move the fracture or attempt the movement, it would pain.
Take care.
fibula fx undiagnosed for 10 months. non-union with large gap, no bone. surg. done/debridement+bone plate, screws. developed non-healing wound which started first day surgical sutures removed with seepage near ankle area. many debridements of this open wound with pale, yellow drainage went on for next 8 months and 5 rounds of deifferent antibiotics for all this time(on bactrim x 35 days at present b.i.d.. Ha surgery #2bone plate removal and more fibula bone necrotic so removed more bone and cannot have a plate again. now diag. with osteomyelitis. lower leg gets purplish blue and turns snow white when push on skin with fingers. when up all day, ankleg, lower leg swells. developed lg abscess at fx site and had to be milked at top of old surgical incision which went down and pus type fl. came pouring out down at bottom where open wound hole was. fib. bone culture showed staphy. auerus and deep tissue culture showed staph. lugdunesis. now, it’s been 6 weeks since emoval of plate, screws and see hole at lower leg where chronic non-healing wound is trying to come back along with a 2nd sunk in area which looks like maybe a 2nd hole opening will eventually appear. Questons: what will be the negative affects of a large area of no fibula bone, lower third of leg cause as far( as running, jumping, twisting body around to look at something, stooping to the floor, using treadmill, long ex. walks, etc, and can you think of any other things wihich may change in my life besides these?).
Dr Arun Pal Singh Reply:
August 27th, 2010 at 9:14 am
@sandy c.,
I need to know the level of the fracture. A recent xray would be helpful.
What are the problems that you are facing in your daily routine life.
forgot to say had hip bone grat on first surgery which was mostly eaten up when they went in on 2nd surgery and this all was debrided with extra fib. bone removed to healthy bone. will the germs get into my bone left and can it develope into a sinus tract and get over into my tibia eventually?
I got my fibula fractured on the ankle 7 weeks back,still the cast is there.There is also a crack in tabula on the ankle. How much time it will take in bone healing and do I need physiotherapy after the cast is removed. when will I be able to walk normally without the walker.
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 6:45 am
@Anu,
Fracture generally heals within 6-8 weeks in most cases. It is followed by pohysiothearpy which may take other 2-4 weeks.
All the best.
I have had a tibial stress fracture since April from overtraining. I have not been running since and am now in a boot and there is still no change. I am taking a calcium supplement with 500mg of calcium and 500iu vitamin D twice a day. Is there something more I can be doing to help speed recovery?
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 6:45 am
@Melanie,
How long you have been on boot? A stress fracture should heal within 4-6 weeks.
Broke collar bone 5 weeks ago – bone slightly attached – had x-ray last week and no sign of any callus forming – x-ray was not much changed from original x-ray. Am I worrying too much?!!
Thanks
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 7:34 am
@Graeme,
No! You are rightly concerned. Absence of callus after this period might suggest that bone is not uniting.
Speak to your doctor if another xray after 2 weeks shows the same