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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This is a very good explanation..its clear and easy to understand. I really happy to get this source and use it as my reference for my presentation on my learning issue tomorrow…
Thank you and just to ask if you can add some more about other stages of bone healing and other factors influencing bone healing such as infection, diabetic or other stuff
Thank you
Taukoriri,
Thanks for your appreciation and encouraging words. I am glad information helped you.
I have made a note of what you have asked and would surely make a post on that
Yes, thank you Dr. Arun Pal Singh for taking the time to explain this process. I recently broke my 5ht metatarsal and was looking for a better understanding of the healing process so I could visualize and help my body heal. Your description was very helpful.
I am glad to see this text.Thank you,Dr.
i meet with an accident my foot toes bones are broken, doctor told me to have rest for 1 and half month, i have to go my office, please suggest for fast healing.
Arvind,
If your doctor has suggested you rest, there must be reason for that.
Bone healing is a gradual process and till now there is practically nothing that would augment healing.
You can discuss with your doctor. If you just have toe fractures, it might be possible to visit office with cast/brace you have after few days of rest.
But you must discuss it with your doctor.
I hope that helps.
I broke (picture this bone-space-bone) my fifth metatarsal and kept walking on it for about 10 days (doctor’s visit was impossible). When I saw my foot doctor, he put me in a “boot.” Unfortunately, after about 5 days in the boot (during which time I walked with crutches), there was a death in the family and that necessitated four days with a great deal of activity on my foot. When I returned (because I definitely felt something else was wrong), one of the broken-bone segments had slid along side the other. Now I am in a cast. My doctor assures me that although I have osteoporosis (I am on Fosamax), the prognosis is good. How long will I be on the cast: weeks, months??Please notify me via e-mail of followup. Thanks
Usual waiting time is 4-6 weeks. Your osteoporosis should not adversely affect your healing.
I hope that helps.
Yes, your response does help! Just that little reassurance is so-o-o good for my mental health! I am normally a very positive person, but I must admit this had me a little down. God bless and happy holidays (whichever you celebrate) !
! No need to respond this time.
I was in a car accident thanksgiving night. Among other things ( including a cracked vertibrea “C7″ which has healed ) I completely fractured and tore my forearm; radius and ulna. They set the bones w/ metal rods and screws. At my 6 week check up the orthopedist said he wished it look a little better. They are now seeing me in another month.
How long should something like this take. I have no other diseases and I am a 25 yr old male. If this helps I do not have any pain at all.
John,
Was it an open fracture? Your records would help you to find this. What I am asking is presence or abssence of wound over the fractured bones.
Why did your orthopedist said so? Dis you enquire further what was meant by that.
Fracture healing takes different times in different individuals. We usually give 6-12 weeks range but by no means that is absolute.
Let me know what else I can do for you?
I had a spiral fracture of the fibula (lateral malelous). im moving on my 5th week since the day of my injury. i just want to know how long would it take me to heal my fractured fibula. my doctor adviced me to see him on april. is there a possibility that my ankle would heal before april. thanks.
Dr Arun Pal Singh Reply:
March 15th, 2009 at 9:20 am
6-12 weeks is the usual time a fracture takes. Because the fracture is spiral, it may happen earlier too if it is well in position
This is a very importent and useful page. This will be helpful for students and other peoples also. I will use this as a reference.
Dr Arun Pal Singh Reply:
March 18th, 2009 at 1:59 am
Thanks Harshanie.
Tibial Plateau Fracture Lateral side , non displaced about 3 cm long , no pain at all , use crutches when i can and when not too tired … how long do these typically take to heal ?
Usual healing time is 4-8 weeks if there is no associated injury.
Hello Doc, I met with an accident in which I have broken my patella and right radius . I was operated for the same , but there is a crackling sound in the right radius , I dont know why this is happening and as to the patella it getting good except wid some pain at times in the adjoining muscles. can u suggest me any particular food that will help heal faster.
Hi Very good explanation,
I had a complete bone fracture of Left Humerus in 2002. The bone was jointed using a steel plate with screws and the plate is still in my body.
Can you please tell me if it is advisable to take out the steel plate now?
And can I do push ups ? Doing so will it hurt my bone in terms of strength and rupture with steel plate?
Thanks in advance.
Krishna
Doctor Singh, by the way I had a spiral fracture of the fibula (lateral malleolus). and it has been 7 weeks and i had my cast removed yesterday. I just want to ask if the bone have callous formation; is there a tendency for it to break again if I will push myself to hard on my rehabilitation therapy? How long should the rehab be? Thank you.
Yashwant,
if you have have been operated with satisfactory soutcome the sound cannot be from bone. It could be sound from gliding tendon.
As such there is no special or particular food for healing of fracture. But you must take a diet rich in calcium and proteins
Krishna,
Until they cause problems, it is not advisable to remove the hardware. TO answer your question, if the fracture has united, the plate can be taken out.
But remember! You would need to protected for six weeks in a cast after plate removal.
If it is not causing any problem, leave it as such. If your bone has united, you can do all the normal activities because the stress would be taken by bone.
Consult an orthopedician in vicinity. Discuss your querie with him.
If there is any confusion, you can ask me any time.
John,
First we need to see that lateral malleolus has united and is in acceptable postion. An xray would help in this regard.
Lateral malleolus takes part information of joint. So your activities would affect not only the mallleolus but also the joint. Start slowly and progress gradually. Our body does not like onslaughts.
Your would be able to decide how much is enough. if in doubt, consult your physio trainer.
My 13 year old grandson is wearing a back brace for a football related compression fracture in his lower lumbar. Considering his young age: 1) approximately how long would you expect it to take for healing to be complete enough for a return to normal activities? (He will not be playing football again.) 2) In your experience, If a patient increases his protein and mineral intake, can the new bone repair become as strong or stronger than the original bone? 3) He is overweight. After he heals, what would be the best activity to lose weight and strengthen his spine? Thanks.
It usually takes 3-6 months. The bone will reach its original strength but compression might remain visible. High protein diet does help in repair.
If he want to loose weight, he should do exercises under supervision.
I hope that helps.
I fractured my left ankle last week and damaged the ligaments. The doctor says I’ll be in a cast for the next three weeks then will wear a boot for a number of weeks after that. Apparently, I do not have a serious fracture, I won’t require surgery, and it will heal wtih little problems.
My question is, when I get the boot, will i be able to walk on it? How long will it take to resume normal activities?
Thank you. (Very good article, helped me understand what is going on.)
This is a very useful page, thanks.
I fractured my fibula when I slipped while jogging. How long do you think it will take before I can run again? Will running damage it? Would wearing a lace-up ankle brace help? Thanks
Yvonne,
It would depend upon the level at which fibula is fractured. if it is near ankle, things take more time to get back to normal than if it was in middle or so.
8-12 weeks is the usual time to normalise the things. Some people might take more depending on soft tissue injury.
i hope that helps.
Vanessa,
Most probably yes but only your doctor can confirm it. Tissues take about 2-3 months to heal completely. if injury is severe, it could be longer.
Dr. Singh.
I had a fibula fracture just above the ankle. This happened on 11th Feb. 2009. I had an ORIF along with K wire. A plate was fixed with six screws. I have been in cast for 11 weeks. The cast was removed on 30th April, 2009.Now my rehab has begun.
Dr. I want to know how long i had to wait for to attain the normal status. when could i start walking. My age is 34 years….Please help.
Srinivas,
K wire and a plate? were there two fractures?
Was there any particular reason that a cast was kept for 11 weeks.?
Please let me know.
Dr. Singh.
I had fibula fracture just above the ankle and right ankle trimalleolar fracture. For which doctor adviced me ORIF as the best option.
On 11th Feb. i was operated. ORIF with 2 k wires and TBW of midial malleolus and 6 hole AO tubular plate on fibula was done.
After ORIF x – ray was done and i was discharged the other day with follow up instruction to visit Doctor after 14 days for review.
After 14 days i went to the doctor . And the SUTURE( hard bandage) was removed. Then the cast was done from the near the toes through the heal till just below the knee.This casting was done on 27th Feb. I was asked to come on after a month.After a month(30th March) X- ray was done and i was told that the report of the bone is good.
I was told to continue with this cast and it will be removed after a month.On 30th April my cast was removed.Now i am told that for next 2 weeks dont put wight instead do “up and down” ankle exercise.Then apply 25% weight after 2-3 weeks and then again after 2-3 weeks 50 % weight on effected leg.
All this has taken 11 weeks. Doctor i am really wondering how more i had to wait to walk on my legs. Please let me have ur guidance and advice. Please Helpppp !!!!!
Srinivas,
You should have mentioned complete nature of injury in last comment. anyhow, if you have had trimalleolar fracture, you seem to be treated on right line.
Operative treatment is the best option for trimalleolar fracture and they do take this much time.
You can consult with your doctor but in my view you should be upright without assistance in another month. Sometimes soft tissues take more time to normalise but that would be better explained by your treating physician.
Thanks Doctor for giving ur valuable comments.
This page is very educative…..the comments given by the Doctors are prompt and useful.
Dr Singh,
I was in a car accident exactly a month ago and had a compression fracture in my L1. They took an xray and CT soon after and determined I had to wear a jewitt brace for 4 weeks and return for a follow up, which I assume is to see whether or not I can start functioning without the brace.
Today was my dr’s visit and they took another xray, but no CT and determined that my spine has remained aligned, but for precaution I continue wearing the brace until June 15th, the next followup.
I want to know is, why did they extend my recovery time. I felt a CT should’ve been done today to look at how much has healed. Overall, I’ve slowly started functioning on my own without the brace and now this news frightens me.
How long does it usually take for this type of compression to heal? and should a CT have been done today along with an xray? I’m a 22 year old female that is completely healthy. I would really like to know.
Thank you!!!
Tiffany ,
You did not mention it but I assume it from your notes that compression was of mild to moderate degrees and there was no neurological deficit. In spinal injuries, protection is given for longer periods. I personally recommend them for up to 6 months wherever required.
It appears that you assumed the removal of brace at your second visit. Because it did not happen so you are getting concerned.
At first time, the CT might have been needed to know the exact fracture pattern. But CT is not necessary at every follow up nor it is done that frequently. Xray is good modality to note the healing and it was done.
Compression fractures as such heal quite well. Usual time taken is 8-12 weeks. Additional protection may be given for longer period if required because of nature of injury.
A brace is usually removed in gradual fashion.
There is nothing to be frightened of. Unfortunately braces do not seem to be very friendly but they offer good support.
As you are young and healthy otherwise, your tissues should show a good response.
Take care.
Dr. Singh.
Does the gap in bone from a small blowout fracture of the orbit fill in with new bone? No surgery was needed.
Hello Dr.
I met with an accident when i was hit by the bumper of wagon R. The car was very slow when it hit me.My right leg caught up under the stationary bike and was injured. Though there was no open wound. I visited hospital after two days when there was no decline in swelling and pain.
X-ray was done. it revealed two fractures. One fracture was on the fibula just above ankle and the other trimalleolar fracture. I was admitted in the Hospital and the next day my leg was operated.Fibula fracture was joined/supported by a plate with six screws and trimalleolar fracture was done with K wire.
I was discharged and was asked to come after 2 weeks. After 2 weeks my bandage was removed and Casting was done.Now i was asked to come after a month.Now X-ray was done and i was told that progress is good and i was asked to continue with the cast for one more month.
After a month i visited the hospital.Till now nearly 12 weeks have gone. This time again X-ray was done and then cast was removed.
I m asked to put weight on affected leg gradually. My age is 34 years. And i m taking a diet rich in proteins, calcium, vitamins and other minerals.
Now its a long time(12 weeks)on rest and really worried and so want to ask u.
1. Right since the cast was removed i had slight swelling and stiffness. Dr. says its normal. When swelling and stiffness will vanish.
2. when can i walk without any help.
3. Wat restriction would be there in my life bcoz of this fracture…..could i ever run
on trade mill in Gym.
Regrds……Bharat Yadav.
Dr Arunpal Singh,
i had a car accident in which my left hand radius and ulna both were broken.It was not open woun , but surgery was done to fix the bone with plates and screw. The union was delayed. After 3 months my callus formation was weak.Doctor prescribed sodium alendronate and calcium tablets now the healing is going fine.Should i remove the plates after the healing is complete or can i leave it like that.Doctors are giving different opinions.My age is 32, they are concerned of the age factor.
Regards
rakesh
Dr Arun Pal Singh Reply:
May 14th, 2009 at 8:53 am
Rakesh,
Plates are not removed before 2 years after fracture has united radiologically. That too if they are causing some symptoms.
Early removal would increase the risk of refracture.
I would suggest you to do nothing if you do not have any problem.
Eight weeks ago I cut through my left arm with a circular saw. It cut 3/4 the way through the ulna about 3 inches below my elbow. I have a plate and screws in, I did’t loose any important tendons. I had an apendectomy 3 weeks ago, followed by a stomach virus. The doctor was dissapointed with my progress. The void in the bone still looked dark in the xray. He’s given me 4 more weeks to heal. If I don’t improve he’s injecting graphing material in. Do you think the extra month will really help. By the way I’m 31, male and, in good health, besides all of what just happended. Thank You for your time.
Dr Arun Pal Singh Reply:
May 14th, 2009 at 8:55 am
Messier,
I would need to have a look at xrays before I could comment. Could you mail me xrays before and after surgery and then leave a comment here so that the mail is not lost.
Jon,
You would need to consult an eye surgeon/ facial surgeon for that. It is beyond my field of expertise.
Bharat,
1 Swelling and stiffness are normal after injury/surgery. As you work out on your ankle with physiotherapy, it would become better with time.
2 That depends on your injury, fixation and physiotherapy but if everything is fine, you should be walking in another 4-6 weeks.
3. Only time would tell that. i hope you are free of any restriction.
Take care.
Hi Doctor,
Thanks for the information. 2 weeks back my son (20 months old) has broken his right hand [just below his shoulder] it got into 2 pieces. Doctors say after 4 weeks we can remove the pluster. please advice me is it a right thing to remove the pluster at end of the 4th week?
Regards,
Anil
Dr Arun Pal Singh Reply:
May 21st, 2009 at 8:35 am
@Anil,
children have a tremendous capacity to heal and it occurs at quite a pace. I think it is okay to remove the plaster after 4 weeks if everything goes well.
two months ago i faced a car accident and i had spine column injury and i was operated now can walk but
i can not run and also i can not bend myself what should i do in order to run or walk fast
navid
Dr Arun Pal Singh Reply:
May 21st, 2009 at 1:40 am
@Navid,
Two months is too soon for all this if you have had a spinal injury. Talk to your physician before you do all this. He/she would be better to guide you on this.
Dear Dr Singh,
i was involved in a car accident about 2 months ago in a foreign city. the x rays and a later CT scan revealed i had a burst L4 fracture of the spine. The doctor -a neurosurgeon- had concerns about a slight compression/narrowing of the canal at the L4 and L3 junction and asked if i had any numbness or tingling feeling in my legs. i had none. He put me on a 4 week complete bedrest treatment without any bracing and allowed for short walking trips to the bathroom.
After 4 weeks i was asked to get a follow up xray and an MRI to show the healing progress. he said that the progress was fine but i would need 4- 6 more weeks of bedrest. i had started getting occasional pains in my ankles and shin, he expressed concern for this but said he would address it after the bone had healed. he proposed a small surgery at a later date to relieve the pressure of the spinal cord at the point where it had narrowed.
i also consulted an orthopaedic doctor who expressed his horror at my being allowed to walk a bit after 4 weeks! according to him, the fracture had actually disjointed more! he told me to immediately get back to bedresting for another 6 weeks! he asked me to use crutches when going to the bathroom and to avoid sitting at all. again, there was no mention of any bracing. he also asked me to keep a rolled towel below ths small of my back to maintain lordosis.
i would like to know how long a lumbar fracture takes to heal and what are the precautions to take in order to aid the healing process considering i’m not wearing any braces. its already 9 weeks since the accident and i need to know when is it safe to travel so i can get back home and continue with the follow up treatments from there.
murtaza, nairobi (but currently in dar es salaam)
Dr Arun Pal Singh Reply:
May 21st, 2009 at 2:27 am
@murtaza,
What i am telling you is the generalised treatment. your doctors are the best person to decide on your treatment as they have more information on your problem.
On conservative treatment, the person needs to take rest for long usually 8-12 weeks or more if required. After that , a person is allowed to move around with a brace. But braces do not prevent any deformity as such. So some people do not prescribe them.
If you can manage to go in lying position I think it is okay to travel. But you need to consult with your doctor for final decision on this.
Take care.
I was wondering when I will be starting to walk after a trimalleolar fracture. I suffered the fracture on 4/4/09, had ORIF surgery on 4/9/09 4″ plate and 8 screws. On 4/22/09, had staples out and was put into the darth boot and told NWB for 4 weeks. I am going to OS in 2 days for a follow-up, what should I expect? Some say I will be PWB, if xrays look good, but still have the boot. How much longer with this injury? I haven’t had any complications, I did not suffer a dislocation.
Dr Arun Pal Singh Reply:
May 21st, 2009 at 1:58 am
@Ebags1,
These questions demand specific answers but I cannot provide you such answers. the best person to ask these is your doctor.
Different people behave differently and very case is unique. So people tell you different things because each one assumes that this is the only course.
Your course would depend on how you have made progress.
In usual course, most of people start walking within 2-4 months.
I hope that helps.
Thanks Doc!!
My OS says I will be back to normal by July 4th. I am progressing pretty well, actually a little quicker than average. I can already dorsal flex my foot, wiggle all toes freely and put my foot down on the ground in a 90 degree angle. Doc also sd that my swelling or lack there of was amazing.
Dr Arun Pal Singh Reply:
May 22nd, 2009 at 4:10 pm
@Ebags1,
It is good to hear that you are making good progress. May you get well soon
I saw my OS and I am now WBAT (50-100%). What type of gentle exercises should I do to decrease the stiffness in my ankle? I don’t have any pain when bearing weight, however the ankle is very stiff. I let it soak in the bath today and that seemed to loosen it up a little.
Thanks for any info you can provide.
Dr Arun Pal Singh Reply:
May 26th, 2009 at 1:35 am
@ebags1,
Warm comprsses and active ankle mobilization exercises would help you to gain back ankle motion.
What kind of conversation would you have with a patient if they had a non severe bone fracture in their foot.
I know that’s a silly question, but I mean, how would you explain it to them in simple terms,
and what would you do about it, how would you help it heal. And how long would it take..
Thanksssss.
Dr Arun Pal Singh Reply:
June 4th, 2009 at 2:35 am
@Kate,
The answer varies according to type of fracture and patient profile and presence of any factors that might affect the outcome.
What I mean is that untill you ask me something specific, I would not he able to answer. If you want to know about foot injury, you need to provide me details of it including the treatment if any.
I would try to keep it as simple as possible :-
Take care.
I had minimally invasive spinal surgery march 24 09. The neurosurgeon advised the procedure was successful. I am still experiencing low back pain requiring medication. The procedure included laser shrinking of L 2,3,4,5 and trimming of osteophytes on the vertebrae. After reading the comments of others it seems to take months for the bones to heal. When should I expect to be pain free.
Thanks.
Dr Arun Pal Singh Reply:
June 4th, 2009 at 2:20 am
Steve,
What was surgery done for and please also let me know a brief about your disease profile.
I need that information before I can deduce anything.
The surgery was to address herniated discs and also to relieve osteophyte pressure on nerves. I had lower back pain and numbness in both feet.
Dr Arun Pal Singh Reply:
June 4th, 2009 at 11:21 am
@steve mensen,
Okay! In that case you must understand that backpain is very complex problem in terms of causes and behavior. While pressure on the nerve roots might be relieved by surgery, cause of backpain could be obscure and not localizable,
As far as I gather you were operated for numbness to relieve the compression of the nerve roots.
But backpain respondes a bit differently unless we are able to localize the origin.
As you have so many osteophytes, it suggests degenerative spine an age related phenomenon. Thus there could be various causes of pain.
You must discuss it with your doctor and ask him if you should expect a complete relief of the back pain.
There should be some but your surgeon would be able to tell you better.
Let me know and we can discuss it further.
Take care
I had a trimalleolar fracture and on fibula near ankle. I had ORIF surgery on 11th Feb, 2009, a plate and 6 screws and K wire. On 26th Feb staples were out and POP cast was done. After subsequent x-rays cast was removed on 30th April, 2009 i.e, after 2 months and 17 days.
For 2 weeks i did ankle up-down exercise and then I started applying 25% wt on effected leg. This I continued for 2 weeks though I was to do for 3 weeks. Then I start applying 50% wt. I use walker. I started walking little more like 700 metres distributed throughout the day( taking regular breaks). Now I feel little pain on the front of ankle(after walk) but disappears after some rest. When day finishes(before sleep at night ) I find swelling on the lower leg(effected part) but next morning the swelling almost disappears.
Is all this normal ? SHUD I CUT DOWN OR PUSH THROUGH A LITTLE MORE IN MY REHAB.
I’m just wondering when I can walk without help. I’m 35 years old, weight 70 kgs, general health is ok.
Please Advice……..thanks in advance
Dr Arun Pal Singh Reply:
June 16th, 2009 at 4:10 pm
@Srinivas Rao,
You seem to be progressing fine. Do not worry about minor swellings. They would go with time.