Both local and systemic variables influence the rate and degree of fracture healing. When normal healing occurs, but at a slower rate than usual, it is termed delayed union. A complete cessation of the healing process, in which fibrous tissue is never replaced by bony matrix, is termed nonunion.
Systemic Factors Affecting Fracture Healing
- Age: Young patients heal rapidly and have a remarkable ability to remodel and correct angulation deformities. These abilities decrease once skeletal maturity is reached.
- Nutrition: A substantial amount of energy is needed for fracture healing to occur. An adequate metabolic stage with sufficient carbohydrates and protein is necessary.
- Systemic Diseases: Diseases like osteoporosis, diabetes, and those causing an immunocompromised state will likely delay healing. Illnesses like Marfan’s syndrome and Ehlers-Danlos syndrome cause abnormal musculoskeletal healing.
- Hormones: Thyroid hormone, growth hormone, calcitonin, and others play significant roles in bone healing. Corticosteroids impede healing through many mechanisms.
Local Variables Affecting Fracture Healing
- Type of bone: Calcellous (spongy) bone fractures are usually more stable, involve greater surface areas, and have a better blood supply than do cortical (compact) bone fractures. Cancellous bone heals faster than cortical bone.
- Degree of Trauma: The more extensive the injury to bone and surrounding soft tissue, the poorer the outcome. Mild contusions with local bone trauma will heal easily, whereas severely comminuted injuries with extensive soft tissue damage heal poorly.
- Vascular Injury: Inadequate blood supply impairs healing. Especially vulnerable areas are the femoral head, talus, and scaphoid bones.
- Degree of Immobilization: The fracture site must be immobilized for vascular ingrowth and bone healing to occur. Repeated disruptions of repair tissue, especially to areas with marginal blood supply or heavy soft tissue damage, will impair healing.
- Intraarticular Fractures: These fractures communicate with synovial fluid, which contains collagenases that retard bone healing. Joint movement will cause the fracture fragments to more, further impairing union. When intraarticular fractures are comminuted, the fragments tend to float apart owing to loss of soft tissue support.
- Separation of Bone Ends: Normal apposition of fracture fragments is needed for union to occur. Inadequate reduction, excessive traction, or interposition of soft tissue will prevent healing.
- Infection: Infections cause necrosis and edema, take energy away from the healing process, and may increase the mobility of the fracture site.
- Local Pathology: Any disease process that weakens the musculoskeletal tissue, like osteoporosis or osteomalacia, may impair union.
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My husband dislocated his 4th and 5th metacarpal bones in his right hand on the 26th of Feb 2011. The doctor corrected it without surgery on the 28th and placed his hand in a cast. He is complaining today that all his right fingers are completely numb with pins and needles. Is this okay? Please advise.. Thanks
Dr Arun Pal Singh Reply:
March 31st, 2011 at 12:55 pm
@Amanda Coetzee,
Reply too delayed for your quesion. Sorry! How is he now?
Thanks a lot for your kind response of my posting from the last Feb 11th, Dr Singh.
I appreciate a lot you effort of informing us about what to expect from our treatments.
I had my cast removed that 15th of february, I’m about to complete 6 weeks without the cast in my wrist. It seems that my bone has healed in a position that won’t allow much flexion (only 30 degrees). Wrist extension is progressing nicely though. Supination seems to be quite a challenge still, need to push it as much as pain allows to get in back into position. Pronation is nearly there. I wonder, is there any time frame to know when you have completed your healing? At my stage I’m still hoping the range of movement will increase.
Thanks again and best wishes
hallo Dr,
i was involved in a car accident in fgeb 8th 2011. i broke my femur bone. i did some xrays today 25th mach 2011 and the report says no callous seen. i have a plate running from my hip joint to the kneee. the fracture is at the middle of the bone. my questions are; 1. after how long does callous develop.2. when can i start putting weight on the leg.3. i have noticed that my right leg which has the fracture is abit more swolen than the left is this normal.
tahnks
mresh
Dr Arun Pal Singh Reply:
March 31st, 2011 at 1:25 pm
@mresh fel,
If there is plate that is fixing the two fragments, callus will not form. The bone in this case would unite without callus formation, a mechanism called primary bone healing.
Provided there is no gap, a femur should have united by now.
Can I see your xray?
hi i have a fracture on my shoulder at the top of the humerous, i have a wide belt around my rib cage anchoring my arm to my body, i have taken off the sling as it is very uncomfortable prob bc its way too big, do you think this is ok? also i have been sleeping in a recliner to speed the process, its been a week since the fracture and am hoping to go back to work on monday, do you think this would be possible, i have to keepmy arm immoblized for 6 weeks ugh!
Dr Arun Pal Singh Reply:
April 11th, 2011 at 2:01 pm
@cherlyn,
Please follow what your doctor suggested.
Hi, I have left foot oblique fibula fracture two months back, it was operated and metal plate was put immediately. after 2 months the recent x-ray still shows the bone is not joined although there is negligble pain and swelling. why is it so?
Also is it possible that the bone does not join forever?
I have started partial weight bearing
Dr Arun Pal Singh Reply:
April 29th, 2011 at 6:13 pm
@Hus,
Some persons may take longer to heal. Consult your doctor though.
Hello Doc,
I had Fibula fracture while Ice skating ( 11th Feb 2011 ) I underwent surgery and plate with screws were put. now after 2 months i took xray and the broken fibula is same ( not joint ) as it was when i took my first x ray.
Although i have negligible pain and swelling. i am putting partial weight on my leg.
Why is the bone not joint yet I am afraid whenever I see my x ray, plz advice
Dr Arun Pal Singh Reply:
April 29th, 2011 at 10:22 pm
@hus,
Can I see your xray?
I had sustained a comminuted fracture in my right femoral shaft that resulted from a trauma. The accident happenned on 14.3.2010 and I was operated on 15.03.2010 whereby the fracture was fixed with an implant fitted with two interlocking screws. Till date the fracture has not united. Moreover recently the distal screw has broken. I had consulted Dr. M.S.Ghosh of Kolkata, Dr. Prakash Khanchandani of Sri Satya Sai institute of higher medical science, puttaparthi and Dr. Sunderesh D C of Ramiah Medical College, Bangalore and all of them suggested for an operation again with bone grafting as the only solution. Kindly suggest if there is any other way by medicines by which the operation can be avoided and the fracture get united. Presently I am taking Ostium K2 and fosavance.
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:45 pm
@Ayon Chatterjee,
More than a year has passed after your initial surgery and bone has failed to unite. It has gone into non union and till date bone grafting is the reliable solution.
I think you need to undergo the surgery as suggested to you by various other specialists.
Hello Doctor,
The site is very informative and am glad that people get reply from you for all their queries.
Thanks.
I have a problem with right leg. 10days back while playing i landed on ground ackwardly, my right leg got twisted. There was pain and swelling near knee and could not able to walk. I was taken to hospital and got x-ray and CT-scan. Doctor said there is a break in tibia, he gave me leg brace and given medicines Dafalgan and Ibuprofen to take daily and also clexane 40mg injection daily. Now i dont have pain so stopped taking Dafalgan, though i feel slight pain some times in a day.
Am 29 years old, even now am very scared to go hospitals and surgeries..
My CT scan reports reads as follows,
Results:
Avulsion of the tibial plate as thorns, with a fragment measuring about 1.7X1.9cm hard, almost non-displaced.
Small anterior drawer, secondary on the divide.
Minimal fracture of the posterior tibial plateau, with minimal enforcement almost nonexistent 1mm, measuring about 1x1cm.
Hemarthrosis associated
Please let me know the injury grade, is it minor or major. If surgery required or not later. How long it takes to walk. Will this fracture have problems during my older days….
Please advise.
Thanks a lot.
Regards,
Sheela
Brussels,Belgium
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:55 pm
@Sheela,
Usually the surgery is not needed for undisplaced fractures. Just keep a watch over it by regular xrays in follow up.
I fell off an industrial work platform and fell twenty feet breaking my femur, just below the hip joint, the diagonal segment, a clean break, now I have a titanium rod attached to my femur, and going into the hip socket, the femur is fused again, not quite solidified, is there anything I can do to get back to normal, I was going to go back to the Army, but I don’t see it is possible, since I can’t run right now, I plan on making a full recovery, and maybe go to Ranger School, or Airborne School, do you have any advice you can give me?
Dr Arun Pal Singh Reply:
July 9th, 2011 at 8:35 am
@Danny Liu,
Would you please add the timeline!
If possible, please send an xray to contact [at] boneandspine [dot] com
Hello Doctor,
I had an accident last year october and had a fractured femur, went in for a surgery but it didnt go well(rod and pins), i later had another one sometimes in march (know i have a titanium rod from ma hip to my knee).. I have been able to flex the leg but havnt been able to work with it yet.. It would be exactly 3months on july 13… I can only put little weight on it… I feel some little movement on site of fracture when moving… I just to now if i am doing well… I would send my x-ray for you to see..
Thanks
Dr Arun Pal Singh Reply:
August 5th, 2011 at 7:05 pm
@Olaniyi Taiwo Oluwadamilola,
Please send xray to contact@boneandspine.com
Hi Doctor,
This is Ayon again. As per your suggestion I went ahead and got my leg operated whereby I got the previous implant (nail in situ with interlocking screws) removed and had plate osteosynthesis and bone grafting. This operation took place at MIOT chennai on 6th June’11. I have been asked not to put full weight on my operated leg for three months from the date of operation. I require to know that how long would it take for the bone to become as it was before the fracture. Presently I am not taking any calcium supplements as nothing of that sort was prescribed.
You previuos reply was:
Dr Arun Pal Singh Reply:
May 13th, 2011 at 8:45 pm
@Ayon Chatterjee,
More than a year has passed after your initial surgery and bone has failed to unite. It has gone into non union and till date bone grafting is the reliable solution.
I think you need to undergo the surgery as suggested to you by various other specialists.
Dr Arun Pal Singh Reply:
August 31st, 2011 at 8:24 am
@Ayon Chatterjee,
The bone takes around a year to return to prefracture state/strength. However limb is functional sooner. The period before limb becomes functional varies with fracture and bone.
Hello doctor….I have acute synovitis in left hip for which i went for a surgery, however its been a months since I underwent an operation, still I have not recovered and I am unable to walk, How long will it take me to recover,Also, what food or medicines promotes growth of synivial fluid in my hip joint,I am in tracson right now,,,,
eagerly awaiting for your reply
Dr Arun Pal Singh Reply:
September 7th, 2011 at 7:47 am
@Kamal Pradhan,
All your questions would be better answered by your treating physician. You have not provided complete info to deduce from.
81 yrs old with spinal fractures
I have several fractures L1-2,L2-3,L4-5, L5-S1 also at T12,T11 . plus sacral ala insufficiency fractures
At my age Ive ruled out surgery,however need to know how long, and if healing of fractures can occur .My injury occurred in feb of 2011
thank you
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:35 am
@mary,
Fractures would definitely heal with time. How are you now?
Dear Doctor, would u kindly tell me what are the information u require.
I do not have any history of arthritis or any other illness or shock, the pain was all of a sudden, I believe I had a acute infection in the Left hip ,a capsule had formed in the joint for which I went for surgery, Doctor had advised me six weeks bed rest but two months have passed and I have not recovered. The pain in my left hip does not seem to lessen, right now I am getting shocks in the nerves in my left leg. It is very difficult to walk without support.
Dr Arun Pal Singh Reply:
September 28th, 2011 at 12:24 pm
@Kamal Pradhan,
@Kamal Pradhan,
What I mean that your treating physician has full information on you including your examination finding.
That doctor is best empowered to give you an answer.
Dr. Arun
I broke my humerus mid shaft in late July 2011. 13 weeks later the OS says its not completely healed but was surprised when he couldnt bend it at the fracture site or even shift it. He then said the xray shows two weeks behind and that clinically its one whole piece. I asked him whats making it one solid piece and he said its callus formation. He wants me to wear the brace for six more weeks. Does callus formation mean it will fully heal by 29 Nov? If not why should i wait until Jan or Feb for surgery. Should I request surgery after 29 Nov appt if not fully healed. My life has been turned upside down now for 13 weeks and in another six weeks I will not be able to cope for another 8 weeks. Please advise as Im ion the verge of a nervous breakdown.
im going insane. Thank you
nov
Dr Arun Pal Singh Reply:
November 19th, 2011 at 9:32 am
@Garry,
However desperate we might become, it is not possible to look into future with certainty,
However, some predictions can be made by looking at present images as doctor has made in your case.
Callus is formed when bone attempts to unite and it is one of the signs by which clinician judges the situation of fracture.
Here is an article that would explain about callus
Fracture Healing
Some people heal slowly and it appears that you are also one of them. But one good thing is that you have a fracture that is healing.
Give it some time and situation should be clear.
We can discuss it further but I require more info from your side.
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.
I had really bad heel pain starting in july 2011 and an mri showed a calcaneous stress fracture. in august i was placed in a hard cast for 6 weeks. after the 6 weeks, my dr told me to gradually go back to walking in a walking boot. not even 4 days of short distance walking, it was unberable to walk on. i go back to my dr and he told me he didnt know what was wrong anymore and suggested i go to a new doctor.
2 weeks later, i saw a new ortho and he recommeneded another mri..i just got those results and the mri shows the stress fracture is basically the same as it was in the july mri. i havent walked on it in 11 weeks (other than the 3-4 days after being in the cast for 6 weeks).
why isnt the stress fracture healing?
Dr Arun Pal Singh Reply:
November 19th, 2011 at 12:08 pm
@becky,
Is it stress fracture! Do you participate in athletics. Stress fractures in calcaneum are known in athletes or people who take up unaccustomed athletic activity.
Stress fracture should have healed with the intervention.
Speak to your doctor if we are missing any thing else.