How Does Bone Fracture Healing Occur!
May 20, 2007 by Dr Arun Pal Singh
Filed under Fractures-Dislocations, Musculoskeletal Anatomy
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 Dr. Singh,
i fractured the shaft of my fifth metatarsal 14 days ago today. the doctor had a cast put on me and said i would need it for five weeks. i got another x-ray yesterday,13 days since fracture, by a different doctor and does’nt think ther has been any healing. over the years, i’ve been unfortunate enough to fracture my cheekbone, wrist, scaphoid, ankle and ribs. all of these injuries healed well and quicker than the time i was initially told they would. the cast is driving me insane as i’m due to play overseas basketball in august, and this is the last opportunity i will ever get at 27. do you think the bone should be showing signs of knitting back together by now, and if it does start to heal, when do you think would be a good time to take off the cast. please tell me what you think i should do.
andrew
Dr Arun Pal Singh Reply:
June 16th, 2009 at 4:16 pm
@andrew,
I can understand your apprehension but injury needs to heal before you can do anything.
Before I comment on your injury, I need to know th nature of injury. Was it displaced? did you have a wound?
I had a humeral fracture in Jan. 2008. After rodding in Feb. 2008 and grafting–morphogenic–in Jan. 2009, I still have no healing of the fracture. Now my orthopedic surgeon is talking compression clamp(?). What are my other options? It’s a clean break mid-shaft.
Thanks.
Dr Arun Pal Singh Reply:
June 23rd, 2009 at 4:49 pm
@Jay,
I do not think I understamd the word compression clamp
Does that mean compression plating.
Because that is a another option in these fractures.
Hi,
8 weeks ago I fell and broke my 5th metatarsal on my right foot. I was put on crutches and a boot, no cast. I just got back from the dr and he palpated the area for pain, to which I had none, but the xray clearly showed the fracture…he said it was most likely filling with soft tissue and I could walk as long as there was no pain, and if that occured to go back to the crutches and boot………….I have been able to walk about 1 hour in total in the last 4 days, but being very conservative I dont want to re-injure the healing area. I am 52 years old, very active, swim, run (well until I broke my foot), a non-smoker. He has me scheduled to come back to see him August 7 (7 weeks away – which will make 13 weeks since breaking my foot), in your opinion, is there an average time when I can resume walking? Anxious to walk again……………then maybe resume running sometime down the road.
Many thanks,
Mike
I meant to also mention, that it was not a compound fracture…..but a closed break. He also called it a Jones Fracture.
Thanks again,
Mike
Dr Arun Pal Singh Reply:
June 25th, 2009 at 4:04 pm
@MIke,
Sometimes the xray may show line for long time.
If you do not have pain, you can work towards walking gradually.
Jones fracture usually do not cause much trouble in healing. It is always difficult to put a time frame but most of people walk within 8-12 weeks with this injury.
Yes. I’m sorry–compression plating.
Thanks.
Jay
hi. i had a right humeral shaft oblique closed fracture, distal 3rd due to fall 3 weeks ago and currently on cast. surgery wasn’t performed. i chose the conservative management. how long will it heal? how many weeks ill be on cast? thank you.
Dr Arun Pal Singh Reply:
June 29th, 2009 at 1:12 am
@mike trillo,
Usual time for conservative treatment is 8-12 weeks followed by physiotherapy.
It is advisable to get frequent xrays for initial three weeks to know if position is maintained or not.
it is all the more important in distal third oblique fractures.
Dr. Singh,
I recently fractured a bunch of metatarsals in my right foot. Last week I had xrays taken 3 weeks post-op, and so far it showed no sign of union. I think that can be normal. I’ll get another xray in 2 more weeks to see if any cartilage is forming around the breaks.
I show a picture of the metatarsals “PINNED” at footsahurtin.wordpress.com/2009/06/06/fractured-metatarsals/ , or you could google footsahurtin and then click HOME.
Since i broke 4 or my 5 metatarsals, how long would you guess that it could be before I am actually walking comfortably again with FULL weight bearing? 8 weeks?? 12 weeks?? Up to a year??
Dr Arun Pal Singh Reply:
July 4th, 2009 at 7:42 pm
@footsahurtin,
I had a look at your images. your fractures have been fixed well and aligned satisfactorily. in a normal course the foot bones take from 4-8 weeks to unite.
Every individual is different but people start walking independently after 12-16 weeks. Some vague pains may persist for sometime but generally foot shows satisfactory results.
Hi Dr. Singh,
I had fall from a ladder on 22nd June 2009 and fractured both my wrists, initially I had a POP plaster . After few days doctor said that alignment in left hand was not satisfactory, on 2nd July , doctor opened the cast and again aligned the bones in both my hands. Now I have a synthetic cast. Pain has subsided but there is pain in fingers and near elbow. How much time will it take to heal.
Dr Arun Pal Singh Reply:
July 10th, 2009 at 1:09 am
@Sam,
Fractures of wrist usually unite between 4-6 weeks. Return to previous function level might take longer.
Dear Dr. Singh
It has been 3.5 months since my car accident where I compressed my L1. The dr showed me my xray and it looks like a trapezoid on that one bone, but thankfully it’s not compressed on the side of my spinal cord. I have stopped wearing the brace and overall have been feeling well except for mornings except for some stiffness occasionally. I was wondering if it’s okay now to slowly begin personal training to build back strength from the time that I’ve been inactive. I would really like to get back into shape. Please let me know if it’s okay. I’m 22 and completely healthy otherwise.
Thanks,
Tiffany
Dr Arun Pal Singh Reply:
July 20th, 2009 at 5:22 pm
@Tiffany,
3.5 months is quite a time to start your back strengthening exercises but you need to ask your physician before you go about it.
Hi..I broke my forehand in the middle of frontarm., not joins..after 3week i have still pain, does it normal..Is it necessary to have surgery..And when the healing occurs..
thanks..
No! It is not necessary to always treat these fractures surgically in fractures which were not displaced to begin with and fractures which have been reduced and held in the same position.
Healing is an ongoing process and takes years to complete. But one can become splint free in 812 weeks.
I hope that helps
Dr. Singh,
It has been around a month since I broke my wrists(both), Pain has also subsided, my Doctor says he will remove the cast on 10th of august, is it ok that I work on laptop and can I start picking up objects.
Regards,
Sam
Dr Arun Pal Singh Reply:
July 22nd, 2009 at 6:11 pm
Sam,
I do not think it should be a problem if you feel comfortable doing it.
Hi! My 6 year old son fractured his radius and ulna in his right arm after falling off his bike about a month ago. The bone specialist saw him and said that the break was angled at 30 degrees, and recommended closed reduction to straighten the bones out. The first closed reduction (while my son was under anesthesia) which was not entirely successful. The doctor reported a week later that while the bone was less angled he was still concerned about the amount of angulation and suggested that we try again. We went to the outpatient surgery again, where the doctor cut the bottom of the cast and “wedged” the cast as he put it, and try to straighten out the bone again. He did this and said that they were able to move the bone slightly, and he thought this would be successful. I took my son back to the doctor two days ago and the doctor said that the bone was still slightly angled, which I understand, things like this aren’t going to turn out perfectly. He then told me to wait 10 days, and return on August 5th to have the cast removed and to be x-rayed again. He told me that we would then decide if he was to be placed in a short arm cast. (He has been in a long arm cast for the past 3 weeks now.)
I have so many concerns, and I feel kind of silly asking the doctor these questions! Do you think that he is going to completely take the cast off after only a month? Or when he said discuss the short arm cast option he ment that he was deciding whether or not to put a long arm cast back on?
I saw the new x-rays this past Monday and his arm still looks quite broke, and I’m concerned that it’s not healing correctly. I was also informed that when the cast is removed that my sons arm may look slightly bent until the bones start to grow back out again. Now I’m concerned that his arm will be weak and easily breakable once the cast is removed.
I’m trying to include the initial x-ray of my son’s arm in my gravatar so you can hopefully get a visual and possibly make more sense between the x-ray and the doctors thoughts. This would be GREATLY appreciated!!
Thank you!!!
Dr Arun Pal Singh Reply:
July 29th, 2009 at 5:42 pm
@Holly,
I am yet to see a healthy child of that age who does not get union of fracture. Union is a kind of rulle in children and if your child has been healthy, you should not worry about healing.
I usually prescribe short arm functional cast in children after taking out long arm cast. It is okay to remove the cast at 4 weeks.
Yes! the arm is weaker for some duration and that is why short arm cast is prescribed for another 2-4 weeks.
Even after that bone takes time to strengthen. It does reach the original strength but till that time one should be extra cautious not to cause trauma again.
And if it is not angled much, it would get better as he grows.
One last thing! You can ask your doctor whatever you want. if it addresses your concerns, it is not silly.
All the best.
Dr. Arun Pal Singh,
I fractured the proximal end of my 5th metatarsal 3 weeks ago and have been placed in a boot. Upon my 3 week orthopedic check-up 3 days ago My physician saw no indication of healing on the x-ray. There is an approximate 3mm displacement laterally with 1mm medially. He said I could have surgery or wait 3 more weeks to see if healing initiates. I am 48 years old, do not smoke healthy weight and eating habits. However was very disappointed to not have seen any sign of healing. Since yesterday I have had a sporadic tingling pain at the fracture site that kept me up a good part of the night. I am not a fan of medication. 1st. Is it ok to take so long for the initial signs of healing. 2nd. What would cause that tingling pain, again it is not consistant.
Dr Arun Pal Singh Reply:
August 2nd, 2009 at 9:01 am
@Janice,
Fractures of proximal end of 5th metatarsal mostly unite without any problem. 3mmX1mm is not a significant displacement. So I think union should not be a problem.
Xray might show a translucent line for a longer time. If you have reduced pain and decrease in tenderness, your body is attempting a healing process.
Wait for 3 weeks and then get yourself assessed again.
Check if your splint/boot is tight or becomes tight intermittently due to swelling of the foot. That may be cause of pain. If it is so, please keep your limb elevated for majority of time.
I hope that helps.
Hi Dr. Arun,
This is in continuation to my earlier posts,my cast of both the hands were removed yesterday, there is some pain in hand motion (a little more in the right hand) and stiffness is the wrists.
I have given a link of my hand photograph, I am concerened about the shape of the hands after cast removal, in the right hand in the red coloured cicrle you can see the bone protruding a little, is it normal?
Do you recommend any exercise.
Dr Arun Pal Singh Reply:
August 9th, 2009 at 2:19 am
@Sam,
If you you do not have any functional difficulty, do not worry about the protrusion.
Consult a physiotherapist (after talking to your treating doctor) who would help you with physiotherapy.
Best of luck.
Dr. Arun,
Good day, i had a fracture almost 6 weeks already, it’s on the left 5th metatarsal. They put me on cast for almost 5 weeeks. then now they removed on they just put tubigrip. But my problem is still there is swelling and pain on the site. Is it normal that swelling is still there and i’m still afraid to put my weight on that site. How many weeks it will take to the bone to be heal.
Dr Arun Pal Singh Reply:
August 10th, 2009 at 10:35 am
@berna,
Pain and swelling may persist for some time but by this time the bone must have healed to allow sufficient weight bearing.
You might take a stick for initial period if you ae uncomfortable.
Dear Dr. Singh,
I am a healthy 65 year old, who fell after falling on very uneven pavement, turned an ankle, and broke my fibula this past Tuesday. The bone was not separated in the x-ray, so the orthopedist gave me a Biomet Brace with velcro fastenings and said to wear it for six weeks. He said that I could walk as long as I wasn’t in severe pain and to just play it by ear. I can remove it to sleep and to shower. I go back for another x-ray on August 25, 13 days after the initial diagnosis. My question is, can I really be walking around, or should I be lying down and elevating the leg? What will help with healing faster? Should I continue with ice or use heat? I want to do everything “right,” but it’s unclear what “right” is. Any advice would be appreciated.
Dr Arun Pal Singh Reply:
August 16th, 2009 at 3:19 am
@Barbara,
Your fibula could have broken in two ways – either by hitting a hard surface or due to twist itself.
If it is broken due to direct injury to it, you can walk as guided by your pain.
But if it is broken due to the ankle twist, it must have caused injury to the tissues on your medial (inner) side of ankle. This would be evident by swelling, pain and tenderness on inner side of the ankle.
In this case, you need to provide rest to the ankle joint for 2-3 weeks+ limb elevation and active toe movement.
In latter case, the fibula would be broken near the ankle.
From your orthopedist’s advice it seems that you just have a fracture of fibula without any injury to ankle.
But if you have doubts or pain in the ankle, you can speak to him again.
Ice is applied for initial few days only. Heat has no role in acute trauma.
I am a 27 year old university teacher in physics.
I met an accident on july 8th 2009. I slipped while driving a scooter.
It resulted in a fracture in my leg. the prescription of the orthopeadic reads like this : ” # LAT.MALLEOLLUS WITH 1/ST, 2/ND & 3/RD M. T.(LT) FOOT ”
Moreover the ancle had twistedand was evidenced by swelling around it and on the back of it also. thogh the fracture was not evidenced in X-ray, the sever pain made us to realize it.
The orthopeadic applied a slab for around 24 days. when the plaster were removed, i went under physiotherapy for around 10 days. And I am still practicing the exercises prescribed by him.
my concern is that even after around 40 days, there is still some swelling around the fractured region. And it increases in measures when I am standing for just 10 minutes or I walk even half a Kilometer. As I am a Teacher in the University. this much walking is a must for me to move from one class to lab to department etc.
I want to know that
1.why does it swell when the fractured part comes under stress?
2. will it have any negative effect on healing of the fracture?
3. what measures should I take to let it heal fast along with my job, as the university is denying me further leaves( I have already taken more than 35 leaves for this.)
4.i am not able to walk properly as well (no other defects are present). Physio and ortho have said that it will come in its rhythm in 3 to 4 months.
Any advice or comments.(please do not mind the language, as I am not very good at English)
Thanks in advance
Dr Arun Pal Singh Reply:
August 20th, 2009 at 2:00 am
@Manish Jayswal,
It is common to have a swelling even after fracture is healed. The swelling is because of impaired drainage of fluid rather than stress on the fracture. This impairment occurs due to injnury per se.
Typical swelling increases when you stand for a prolonged duration or walk for somet time. The reason is again the same. Because these positions put foot at further disadvantage.
But except for unsightly look and shoe wear problem, the swelling does not cause much of discomfort. It would go slowly with time.
Following measures help in tackling with this problem.
Avoid standing for long time.
Wear a good loose shoe/sandal/slipper with allowance for swelling.
Raise your feet intermittently on a stool when you sit.
Avoid keeping your foot in dependent position when you sit.
Continue your mobilization exercises as advised.
Things would get better with time. All the best.
I am a healthy 53 year old man who eats healthy and doesn’t smoke. I fractured the tip (tuft?) of my left big toe when a guy at work dropped a 70 lbs object on my toe on April 10th. The impact shattered the bone and there are several breaks radiating out from the impact zone. I have been to 3 doctors and the first doctor would not give me anything and said they can’t do anything for a toe tip break. They sent me on my way and I subsquetly hit and injured my toe six times before they would give me a boot. I had to modify the design of the boot sice wearing it caused more injury to my toe.
The last xrays clearly show a shattered toe. The orthopedic sugeon thought I had soft tissue trama when a tender lump formed under the toe appearently pushing up the bones and keeping them apart. An MRI was done and he took a quick look at them and thought it was a healing fracture and not a non union as originally thought. I took a closer look at the MRI and clearly see jagged dark lines indicating a break. Some look as wide as 1 mm. What should the breaks look like if they are healing? Should the lines be white in an MRI or Xray if they are healing?
I have painful swelling every night and yeasterday he said I should try to walk and put weight on the foot. I walked around all day today on it and now have more swelling and pain. The doctor told me to wrap my toe tightly to the to get the lump to go down. This doctor thinks that there is nerve damage and that is causing the swelling not the break. He wants me to have a “sympathic nerve block” done with an injection to the spine to temporarily shut down the nerve and reset it.. I don’t like the sound of that! It has been 138 days since the break occured. Is this normal ? Will it ever heal? This last doctor seems disinterested in helping me since he sees it as such little break.
Dr Arun Pal Singh Reply:
September 6th, 2009 at 11:09 am
@Randy Mills,
Sorry for the delay. Could you please mail me an xray and a photograph of your toe.
I need to take a look.
Hi Judy here i fractured my 4th 5th metatarsal 8 weeks ago it does not hurt anymore but as soon as i start walking my ankle and the top of my foot swells it is fine if i keep it elevated is this normal after a fracture and how long will this take to go back to normal
Dr Arun Pal Singh Reply:
September 6th, 2009 at 11:11 am
@Judy,
Yes. It can occur in some people and the time taken to to go back to normal may be frm few monthd to a year.
Try to avoid prolonged hanging of the foot.
My wife fell down on a slippery floor and suffered fracture on her right leg on 16th July 2009. Next morning she felt swelling and pain in the leg and was not able to move the leg she attended a local orthopedic centre where the doctor pur a plaster on her leg and advised for six week’’s rest. The plaster was removed on 20/08/2009 and a xray was done which showed the fracture has healed. She was advised 4 week’s rest. But she is not able to walk and a sort of filthy smell comes from her feet. What is your advise. Should we take a second opinion by visiting any other orthopedic centre? Please advese.
Dr Arun Pal Singh Reply:
September 6th, 2009 at 11:13 am
@Muhammed Ismail Kola,
What was the injury? Was there a wound.
How is she now?
Dr Arun- On July 21, 2009 I sustained fractures in my 4th and 5th metatarsals. I was put in a splint by the ER and then was sent to a Ortho were they put me in a cast. 2 weeks later I go for a recheck and of course there is no sign of healing (that seems to be a common thing) so I am put into another cast for 4 more weeks with crutches. I am still able to work with the use of my crutches but I know that my boss isnt going to keep me around for much longer with a broke foot. I really need to get this foot healed or I am going to lose my job and not be able to support my family. What I really want to know is is there a higher chance that I will have to have surgery OR is there more of a chance that the fractures will heal within the normal time limit. I read an another website that it can take up to 20 weeks for them to heal and it has me just a tad bit worried. I am 21 years old and very anxious to get up and start walking, driving, dancing……all the fun stuff that I havent been able to do in over a month! From what I know there was no displacement and the bones were aligned at my last visit. I have also been taking calcium supplements (not saying that I do not get enough in my diet or that I broke my foot due to lack of it) but I have heard about all of the benefits that calcium can have on the bones and thought that maybe the calciun could maybe speed up the healing process or make the bones stronger. Are the calcium supplements worth taking? Thanks for your time!
Dr Arun Pal Singh Reply:
September 6th, 2009 at 11:26 am
@WillJam,
Metatarsal fractures heal most of the times until they are open or associated wita pathology or are displaced widely. The sign of healing on xrays may not appear untill 3 weeks. So do not worry about that.
By your description, your fractures must have healed by now enough to let you walk with a stick.
Calcium supplements are useless if you are taking a good diet.
Thank you for your response. I have a PDF file with my x-rays, MRI and photographs of my toe. How do I send them to you? Do you have a regular email address?
Dr Arun Pal Singh Reply:
September 15th, 2009 at 3:36 pm
@Randy Mills,
Please use contact [at] bpneandspine dot com
Hello Doctor……….
In Feb. 09 I had an ORIF with six screws an plate for my fractured Fibula towards ankle and also ‘K Wire’ treatment is done for fracture at ankle joint.Final cast is removed 4 months back. Now i am in the seventh month when i have started walking normally without any help.There is no pain or swelling even if i walk a kilometre morning and evening. But only swelling occurs when i am out of home for 4-5 hours when i am either walking,standing or sitting positions.Even for that outing i have no pain but swelling.
But Doctor i want to ask when a) when can i get rid of swelling during longer outings.
b) There is a belief that during winter seasons, pain occurs. Is it true ? It
really scares me.If it’s true, what remedy is there.
c) I have started working in Gym for upper body since last three weeks(by
doctor consent) and i didnt feel any uncomfort or pain. Doctor will i ever
be able to do jogging or running in future.
d) Six months gone and 1 more year is left where i can have the option to
remove plate.If i do not go for removal of plate in the entire remaining
life, then will the plate cause any adverse effect.
Many Thanks in advance,
Srinivas Rao
Male 35 years
Dr Arun Pal Singh Reply:
September 15th, 2009 at 3:44 pm
@B Srinivas Rao,
The plate does not cause any harm as such. It needs to be removed only if it is causing discomfort.
Swelling would go by and by.
You are doing quite fine. It is not good to be apprehensive.
Dr Arun,
I’m a 49yo female with osteopenia post-oophorectomy. On Memorial Day an object fell on my left foot from the top of a fridge. I had really sharp pain the rest of the day, bruising and swelling, with point pain on the top and bottom of the area of the 2nd and 3rd metatarsals… but hard to localize with all the bruising.
Urgent Care said I most likely have a fracture, but the podiatrist wasn’t sure, so he prescribed ice, ibuprofen, and a stiff surgical shoe, and the pain receded over weeks. However, even this last month it still throbs when I walk on it in barefoot, and, more disturbingly, when barefoot I have a sensation of a pebble on the underside of my foot, under the 2nd metatarsal. Also some tingling and partial numbness under the metatarsal, some pain shooting into the first and 2nd toes, and still point pain with some movements — but I can move the toes. I can stand on my tiptoes without pain, but I don’t feel the floor as clearly with that part of my left foot.
(I feel embarrassed that I hadn’t caught this earlier. What I’ve just figured out is that I don’t feel the pain in SAS sandals, which have a well-padded sole. (due to painful peripheral neuropathy I normally wear well-padded SAS sandals, even indoors, and put them on as soon as I get up) .. So I only feel the pain when I am in less-padded shoes, or barefoot on a hard surface, e.g. when showering ).
Now I am concerned that I may have a partially-healed fracture, but with the bones misaligned, irritating a nerve. What should I do at this point? Assuming it is a fracture, what can be done this late after the injury? And, if the podiatrist didn’t see a fracture on the x-ray 3 days after the injury, would it show up now? If it is not a fracture, what else can be going on?
Thank you!
Dr Arun Pal Singh Reply:
September 15th, 2009 at 3:29 pm
@LucyB,
Fractures usually do not result in such symptoms and metatarsal fractures should be visible on xray on 3rd day. You said you have painful neuropathy. It is possible that that has worsened.
Morton’s metarsalgia is another possibility.
Discuss it with your doctor. Another xray can help to confirm fractures.
I hope that helps.
I broke my left hand ulna and radius bone in a bike accident.. I am 28 years old. They have fixed my bone with DCP and screws on both ulna and radius bone.Now its almost 6 weeks and the cast is put below elbow. Doctor said that he will remove the cast after 2 weeks. Can i ride the bike after my cast is removed. I would like to know when the DCP will be removed from my hand? Is there any harm if it remains in my hand? Will they operate again to remove the plates? Please let me know in detail. Thanks…
Dr Arun Pal Singh Reply:
September 15th, 2009 at 2:54 pm
@Satish Nayak,
Plate removal is not advised if it does not cause a problem.
If required it is recommended that a plate should be removed after fracture has healed completely and that is usually 1-2 years.
Yes! There would be repeat surgery of the same magnitude and you would need a cast for 6 weeks to protect the bone after plate removal lest it might fracture.
I broke my fibula bone about 1-2 inches above my ankle on September 5th. ER placed me in a hard splint with bandage wrapping and next day my DR – she is a DO- . placed me in a boot type cast with Velcro and crutches and told me to come back in two weeks to see if it is healing correctly. Said if it is, I can ditch the crutches and start using a cast for an additiona two weeks at which time I can ditch the cast and just use the cane for weight bearing. Does this sound right? I am 54 yo female in relativeley good condition – I normally work out 3-4 times a week. When can I expect to be back at the gym? I am anxious. Thanks
Dr Arun Pal Singh Reply:
September 20th, 2009 at 8:00 am
@Jacki,
Line of treatment seems fine to me.
You can still work out on rest of your body.
I hope that helps.
i got shaft of femur broken or u can say compound fracture.Intramedulary nailing was done in may 2009.now the doctors says they need to pull the screws one each from both end as the fracture site stills lacks union, its over four month.Well i have no problem in walking without support ( although a little limping is there).
Should I go for that operation?. Is it needed? will it be a beneficial one?
Dr Arun Pal Singh Reply:
September 20th, 2009 at 8:14 am
@ajitendra,
If the fracture has not united, the nail is taking all the weight while you walk. One day nail would fatigue and will not support your weight.
Before that happens, your fracture should unite.
Pulling out screws would allow the gap between the fractured fragments to close and therefore enhance the chances of union.
But usually we remove them only on one end.
yes I broke my metacarpal # 4 going on 2 weeks ago and have had a cast on now for a week with my middle finger,ring,and pinkie pinger enclosed in the cast with it bet due to the slight rotation of the bone. My questions is , should I still be feeling a noticeable pop in my hand where I broke it? Also the swelling is very noticeable with great pain. Do you think I need to go have the cast cutoff and have the xray taken again to see if i need to have it pinned or plated?
Thanks!
Dr Arun Pal Singh Reply:
September 25th, 2009 at 8:24 am
@Chris Ivie,
Your doctor must have had an xray after the cast if the fracture was originally displaced.
If that position is acceptable, it is unlikely to change unless strong forces are applied on the hand.
If it was undisplaced tobegin with, it is even more unlikely to get it displaced.
The swelling could be due to callus formation.
In any case surest method to confirm the position is the xray and you do not need to remove plaster for that.
hi doc, i have a stress fracture of the second metatarsal shaft. the alignment is fine so i was place in aircast end of may. The onset of pain was mid may and i am still in aircast and it is now September 24th. The orthopaedist took xrays and said everything is looking fine and i should keep the aircast on and use crutches so i dont put weight on the foot. sometimes i dont use crutches around the house because i have to do things for my little daughter. when do u think i will be fine. Its already been 5 months and i am fustrated and depressed. the foot(r) swells if its hanging and sometimes there is some tenderness. is it normal for a second metatarsal fracture to go on for that long? Help!
Dr Arun Pal Singh Reply:
October 2nd, 2009 at 2:12 am
@Eva,
A stress fracture should heal within a month and if the symptoms have persisted this long, I think you should discuss with your doctor.
It should not be tender after 5 months if it was stress fracture.
u should know i got this fracture after i increased my running by 4 km. its a stress fracture the Orthopedist said.
Thanx Sir,
Sir you mentioned about the nail get fatigued (If the fracture has not united, the nail is taking all the weight while you walk. One day nail would fatigue and will not support your weight.)
so what should i do to avoid this?
how much time is needed for the fracture to unite( its already 5 months and still there is a gap of around 1 inch)
well i have no other disease per se. i am 24 yrs.
Do i need to consult any other orthopedic surgeon.?
should i go for dynamization?
Dr Arun Pal Singh Reply:
October 2nd, 2009 at 1:56 am
@ajitendra,
Please discuss the options with your treating doctor. you are free to take second opinion anytime.
If there is a persisting gap you need to evaluated for treating that, most likely with surgery.
My son who is 12 broke his spiral break to his tiblaabout 3 weeks ago. Could you tell me why we still have pain and still take pain pills. Also his toes still swell. Do you think they should put a plate in there. Please give me your opionion.
Thanks
hi doc i just wanted to know if i should heel my broken finger i went to the docotor and he told me i need to see a orthopedist but i think that is a waste of time cause i need to stay at work or i will lose it for broken finger but i can still move it not all the way i am exercise it everday and i think its getting bettter so should i let it heel on its own oh yeah and the reason of the broken finger is cause i was finger wrestling thank you
Dr Arun Pal Singh Reply:
October 2nd, 2009 at 10:50 am
@bigboy,
Please see a doctor so that you can be diagnosed properly and get treated accordingly.
Symptoms would get better in spite of lack of treatment but may lead to residual dysfunction.
It is better to invest some time for your own sake.
good luck
Hey Doc!
This is just an update and a couple of questions. I went to my last appointment almost a month ago and my foot is healing quite well. I have been given a walking boot with the instructions to use my crutches if needed.
The foot is feeling fine and doesnt hurt at all but my ankle swells up and is very stiff if I do not use it for long periods of time. Could this be fluid retention? My ankle only hurts when I twist my foot. Do you have any suggestions as to what I can do to ease the swelling? P.S. When I sleep the swelling goes down but it is harder to walk on my foot. Is that normal?
Dr Arun Pal Singh Reply:
October 2nd, 2009 at 10:57 am
@WillJam,
This happens in ankle and foot injury. avoid prolonged standing or sitting with foot in dependent position.
The swelling is due to inefficient drainage of fluid in presence of gravity. This is a common phenomenon and may take quite some time to go.
Gravity can be avoided by keeping your foot on table or stool when you sit.
In standing and walking it is unavoidable but can be minimized by avoiding continuous standing or walking.
nice how you don’t answer my question!
thanks not
Dr Arun Pal Singh Reply:
October 9th, 2009 at 1:45 pm
@Joanna,
I am sorry. What question?
2 weeks ago I fractured a metatarsal when I sprained my ankle…the pain I have now is different. If I hold my foot and ankle perfectly still it will be fine,, but if I am up and moving around in the boot and on my rolling cart, it feels like muscle spasms in my foot and up into my leg..the only way to relieve it is to take off the boot and hold it perfectly still and if I can take a vicodan. Is this normal? I have never broken anything before.
Dr Arun Pal Singh Reply:
October 9th, 2009 at 1:59 pm
@Barb,
It might be that your boot is not immobilizing enough during walk.
Please talk to your doctor.
A couple of days ago. Me and my friend(s) were messing around on the field at our school…. We was rugby tackling each other, he was slightly heavier than me and he fell on my leg. I heared a big “Crack”, So i paused for a seconed. and i noticed my left leg really hurt. So they forced me up and tried taking me to the medical room when we got half way there, a teacher came and dealt with it from there. I had an ambulance to our local A&E (Milton Keynes General) I was in there from 1:30pm to 5:45pm. I got X-rayed and i got told i had a break on my left leg (The seconed biggest bone in the body – Between my Ancle and the underside of my knee) i got put into a cast for 1 week to see if it got any better, it didn’t so i had that cast removed, and i am now in a permanant cast for 6 weeks…
The only main thing i would like to know, is….
…will it heal and go back to it’s normal strength if not stronger?
Bottom line – Hey what are friends for…..?
Dr Arun Pal Singh Reply:
October 21st, 2009 at 3:15 pm
@Ashley M,
Yes! A united bone reaches its normal strength eventually.
Hi Dr. Singh,
I injured my foot last week Oct 9. The official result of the x-ray for foot injury is “Undisplaced fracture of the base of the fifth metatarsal”. The doc said to continue with pain medication if I need it (I’m not in serious pain, but am facing discomfort) so I am not taking any pany killers. Doc also said to continue with rest, ice and elevation and to tape the last 2 toes together and that it should heal within 4-6 weeks, possibly in 2-3 with very good care. No cast given, no crutches given. I have been working from home this week, but doc said it’s okay to go back on Monday the 19th as I work in an office and am not on my feet all day.
However, I have been looking at various internet sites and researching on my own – I’m getting mixed messages for injuries of the fifth matatarsal – some a cast is required.
What is your opinion? Is it normal not to receive a cast or splint or anything for this kind of injury? Please advise – thanks.
Dr Arun Pal Singh Reply:
October 21st, 2009 at 2:56 pm
@Karen,
the treatment varies from fracture to fracture and person to person.
I generally prescribe splint but the fracture can be treated otherwise if not associated with displacement or severe soft tissue injury
Hi,
My 12 year old son broke his arm just above his wrist the radius and ulna Bones about three weeks ago during ice hockey practice. The doctor did a closed reduction to get the bones back in place. The bones aligned good and he is now in a short arm cast for 4 weeks. He wants to get back out on the ice and skate but if he falls can he rebreak the arm in the cast? Also in 4 weeks they will be removing the cast if he would wear a good arm brace while skating would that protect his bone if he fell? Any input would be helpful.
Thank you,
Ken
Dr Arun Pal Singh Reply:
October 21st, 2009 at 3:07 pm
@Ken Barbusca,
A newly healed fracture does not have the strength of the original bone yet.
A brace does not protect against major trauma.
My advice would be to avoid falls at all. That might mean avoid skating for few months altogether.
@Ashley M,
Yes! A united bone reaches its normal strength eventually.
i suffered fibula fracture lower 1/3.There is no twisting of ankle in it.The bones have not seperated n its a hairline fracture.i am in cast 4 seven weeks.I am serving in army n i wana know if by end of december I will be able 2 return to full duty?after that I can manage 2 months leave in feb n march next year.Will it be fine totally by then?
Dr Arun Pal Singh Reply:
November 1st, 2009 at 3:05 pm
@alok,
Fracture fibula does not cause much problem as the bone is not weight bearing. Most of the weight is borne by other bone-tibia.
As you have just a hairline fracture, you should be better in 4-6 weeks.
Hi,
I broke my 3rd & 4th metatarsals f weeks ago- the 3rd was slightly displaced but not operated on .
I had the cast removed this week consultant stated that there was no point in re x ray. the only advice I was given was to start weightbearing with crutches when ever it was not painful -however it is really painful, much more so than when in plaster, I can put the foot down, but not stand weightbearing in any way and cant get shoes on – I have no idea how long it may take to get back on my feet properly, I work as a nurse and obviously there is pressure to get back to work but I cant estimate how long this might take. I would appreciate any advice, I have purchased an aircast and I can get around with this and crutches for a few minutes.
Dr Arun Pal Singh Reply:
November 3rd, 2009 at 2:27 am
@Jo McG,
First thing to know is whether fracture has united or not. Especially if it is painful. Surest way to tell is Xray.
If fractures have united your symptoms would improve over next few weeks.
P.S. I am sorry I missed answering this before. Your second comment was similar so I have not published it. Anyhow that made me look whether I answered your earlier query or not.
Hi Dr. Singh,
I had a bad fall while roller skating with my daughter and had a lot of pain in my leg. I have been to the doc
two days later and got a x-ray done to find that i had a proximal fibula fracture (not sure what it means..but know its a broken bone)…Doc gave me a walking boot and said to use crutches if needed. Two weeks later had a follow up visit and Doc said that it has not displaced and it might heal and no need for a surgery. And told me that i should try put some weight.. i stopped taken all pain killers… no i am having pain while moving my leg up and down straight..is this common.
in the mean time my ankle and fingers have swollen..i am not sure if the treatment is right ..i mean without the cast..just with the boot ( btw i am removing the boot in the nights at sleep and for shower from 11days since i got the boot as per doc’s advice that i can do it)…i this all right
Really appreciate your help
Dr Arun Pal Singh Reply:
November 1st, 2009 at 4:08 pm
Fibula is the smaller bone of the two bones. Proximal end is the upper end of the bone near the knee.
You seem to be progressing fine. Things would get better with time. Ankle swelling can occur if foot is kept in dependent position. Try to keep it elevated when you sit. A chair or stool would help.
thank you Dr.
(plz ref my querry dated Oct 26th)
thanx a ton doc..For how long should I take physiotherapy after the cast is out
Dr Arun Pal Singh Reply:
November 5th, 2009 at 2:18 pm
@alok,
usually 2-4 weeks is fine. You would be guided by your own condition
Hi Dr. Singh,
5 weeks ago I broke my clavicle playing football. It happend in such a way that it is broken just over halfway along the bone but at the end closer to my shoulder. The bone coming from my sternum is raised upwards and the bone from my shoulder is touching at the bottom of the part coming from my sternum (such that it forms a upside down ‘v’ like shape. Most of the pain has gone and i have wide movement back, however i have not developed the lump associated with new callous formation and indeed my x rays after 2 weeks showed no new bone formation ( i was told this may be normal due to early stages and lack of calcification at that stage?). Occasionaly i can feel like a clicking from the bone that is painless. Do you think its a possibily that it is non union and if so is it still an early stage by where bone may form (if it hasnt already)? I am told that if it is non union as it is slightly raised it would be dangerous as it is not supporting my shoulder. I am just concerned about surgery in the main.
Any help would be much appreciated
Dr Arun Pal Singh Reply:
November 5th, 2009 at 2:24 pm
@Ags,
Non union is less common in fracture of clavicle but can occur.
It is too early to call it a non union.
Get an xray after 6-8 weeks of trauma and it would be better revealed if fracture has united
Hello, Dr Singh.
I have a comminuted fracture of 5th metatarsal Oct 14th. I have been wearing a walking cast ever since. On the 4th day post injury, I was able to do full weight bearing with my cast on, and was pain free, except for occasional pinch or shooting pain for 3 secs only. On the 3rd week, my calf muscle started to have cramps.
Do you think I am healing well? What is the cause of my shooting pain…impinged nerve? muscle cramp from muscle tension? I took off my cast with good relief and massaged my aching muscle.
Any in put is most appreciated.
Broke my wrist on the 5th August 2009, straight break on the hinge, not sure what else to call it:). Plaster off on 16th September, still have pain and stiffness in my wrist, although I exercise daily. I am a learning disability nurse and I am unable to have contact with my patients as I am unable to do the management of training and aggression course. How long will I have to wait for the pain to reduce and my wrist to get back to normal? As there is no shape and it still swells up on a daily basis, I cannot carry heavy objects and I am very frustrated at not being able to work with my clients. How much longer will I have to deal with this? And will I ever do cartwheels and handstands again:) thank you
Dr Arun Pal Singh Reply:
November 12th, 2009 at 12:31 pm
@coral,
What bone was exactly involved.
Was there an associated ligament injury?
Have you got an xray after injury.
As wrist contains many bones and you did not mention it, so I need to ask.
Hi Dr. Singh,
I had a Galeazzi fracture and the radius was set 9 weeks ago with a plate and 6 screws (I fell from a standing still position on rollerblades).I am concerned about several things now at this stage of healing process (my Dr. is not very communicative for me). I am a 48 year old helathy, physically fit petite woman.
1) He said that X-rays at 6 weeks showed that bone ‘hasn’t healed’.
X-ray at 8 weeks showed “some healing’.
I also noticed in the 8 week X-ray a round swollen -looking white area around bone – is this soft or hard callus formation or somehting else ? Is this a stage that healing should be in now /normal progression or is it slow ? I’m afraid of non-union happening.
2) Also, I have pain where the fracture is when I write for short periods of time from the pressure of bearing down with a pen. Is this okay ? Does it help the healing (increased blood flow?) even though there is pain ? Or does this mean I should not write because is detrimental to the healing (I need to for work sometimes) ?
3) The dislocation of the distal ulnar joint is prominent and I don’t think it looks normal. First Dr. and 2nd opinion don’t say much about it – just wait and see if when ligament/tissues under it settle down maybe it will get better. What can be done if not ?
4) I want to have the plate/screws removed when possible because I am thin framed and very active and one of the screws is visible and prominent. I am afraid about possible nerve or other damage that can happen from the removal. How safe would it be ?
5) Concerns about arthritis, does this always happen ?
6) I am 48 years old in excellent physical health, should i still get a bone density scan due to these circumstances ? My Dr. says I don’t need one until 60.
Apologies for so many long questions but I am so nervous about all this – I appreciate your help.
Dr Arun Pal Singh Reply:
November 12th, 2009 at 12:52 pm
@Susan,
I understand your nervousness and concern. It is not an unusual thing. We all get worried about ourselves.
I do not have your xrayu pictures to look at. So my answers are based on deuctions I made from your description.
At any given time a doctor whom you can visit physically especially your treating doctor is in position to answer them better.
1) After a rigid stabilization as in your case fracture healing may not be visible on xray for long time as callus formation may not be there.
But some amount of callus can also be seen. You can read more about this here
http://boneandspine.com/fractures-dislocations/primary-and-secondary-bone-healing-in-relation-to-fractures/
What yuo describe seems to be a hard callus.
2) Pain in fracture site may occur and it varies from one individual to other. Your this activity per se should not affect bone healing either way.
3) Usually after radius bone is fixed in Galleazi fracture, the distal radio ulnar joint gets back into its position. I need to look at the image whether it has relocated or not. If you wish you can send me one.
4) Plate removal is not advised before 18-24 months. It would not cause any problem if it stays there. the removal is advised only in case of problem.
It would be a surgery of almost similar magnitude and you would need your limb to be protected in a cast for minimum of six weeks.
So I would advise not to think about it if you are just wishing to get it removed without any other reason.
5) Per se not if the joint has been relocated.
6) There seems no need for that as your doctor advised.
At present the first goal is fracture union and that should be main focus.
I hope that helps. All the best.