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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hai, i was trying to find a reference for my 5th metacarpal,shaft frecture.first of all i appreciate and thanks for the help in advice. I am in canada, and on a friday 2 weeks before i got my both 5th metacarpals fractured,was taken to the emergency,they put a plaster cast and then withina week the plastic surgeon called me,and he made a small correction in my right finger as it was not folding straight and then i am placed now ina new cast,the cast is such tat the hand ftrom my elbow down to the palms are casted and my fingers are free,but my 4th and 5th fingers have been buddy taped.
now my question is
1. doctor said i will be able to use my hands in 2 weeks and has called for removal of caste next week that is 2 weeks after my last visit. i am curious that ,will a bone heal in 2 weeks?there was one week prior to this 2 weeks but after that only he corrected the bone.
2.since my fingers are free there is occasional movmts of my fingers ,as i have to do all my stuff,will this affect my healing?
Dr Arun Pal Singh Reply:
March 30th, 2010 at 11:23 am
@dany,
1. In 3 weeks fracture becomes sticky enugh to permit mobilization.
2. It should not affect the healing.
Hi, I just had a question about fractures
would a young 9 years old child with an oblique fracture of the diaphysis of tibia be able to return to her usual sport activities within the next 3 months?
Thank you,
Chanel
Dr Arun Pal Singh Reply:
April 7th, 2010 at 6:51 pm
@Chanel.s,
It is always difficult to comment on the query when I do not see any picture.
Inn any case I think it would take slightly more time
What is the difference between a stress reaction and a stress fracture? I have a “mild” stress reaction in my femur (mid-shaft) however the only place where I am feeling pain is in my knee. My dr told me that I could walk using a cane but the pain in my knee is worrying me so I have been using my crutches instead.
Dr Arun Pal Singh Reply:
May 10th, 2010 at 3:02 am
@Carolyn,
I am not aware of term stress reaction. Stress fracture is the fracture that occurs when body is subjected to repetitive forces which are more than it can tolerate.
For example a non jogger starting heavy jogging is prone to get stress fracture.
Hello, I broke my collar bone on a car crash impact from the seat belt about 4 weeks ago. I was told by my doctor as well as an orthopedic that it should heal fine and x rays i throughout the time show displacement but is typical with collarbones.
My question is of concern.
The x rays taken today at the orthopedics office show the bone attached to the chest area in an upright angle almost like a ramp, it isn’t raised or anything radical, but the tip of the bone where the break occurred is curled up opposed to down like many x rays i’ve looked at seem to show. Also the other part ofthe bone where the break was is not attached to other part of the bone instead it shows slight connection but mostly displaced. Will this cause damages longterm? Should I seek a second opinion? I’m trying to get into the Air Force and am nervous it isn’t healing properly, or was set in place for that matter looking at the x ray.
Dr Arun Pal Singh Reply:
July 4th, 2010 at 7:00 am
@Steven,
Usually it does not cause any functional problems and unite well.
But non union can occur in clavicle too.
If you want you should get a second opinion. There is no harm.
Hi Dr. Singh,
13 weeks ago I fractured my right foot. Initial xray found a closed complete mildly displaced fracture at the base of 5th Metatarsal (acute Jones fracture). On the 10th day (from fracture) I had a lower leg fiberglass cast. Six weeks later, before the cast was removed another xray was noted with intraarticular extension and minimal displacement of the fractured fragment. Rehabilitation ensued for almost a month. Finally, I had another foot xray (12th week): there’s a union of chipped fracture but the reconstitution is not precisely in place. Visually, the distal tuberosity has left a snip mark that misshapen it. Though I can now wear my 2.5 in heels shoes, at times mild pain hits the fractured site. Is my reconstructed Jones Fx at risk of refracture until the bone has totally regrown?
Thanks,
Carol
Dr Arun Pal Singh Reply:
July 5th, 2010 at 1:14 pm
@Carol, It is not likely untill trauma is very strong.
Dr Singh,
My husband suffered a fracture in his fibula about 7 weeks ago in a motorcycle accident. It was a diagonal fracture just above the ankle, but it was not a through-and-through cut. There was also swelling on his foot, presumably due to muscle and ligament injury. His foot, ankle and calf were bound in a soft cast for 1 week and then in a harder cast for 5 weeks. When this cast was removed, he had an x-ray taken. The crack in the bone appeared to be the same as in the x-ray taken at the time of injury (in fact it appears half a millimetre wider). The total width of the crack is maybe 1.5mm at its widest. But he was told that ‘calcification’ had occurred, and that the rest would take a year to heal. This diagnosis is causing us some concern, since he is experiencing increasing pain at the fracture site with each passing day. This is in spite of wearing a crepe bandage and heat treatments as instructed by the doctor.
Is this a case of delayed union? He did jar the injury 4 or 5 times while the plaster cast was in place.
What should he do to ensure he doesn’t aggravate the fracture more? And will he need further treatment to join the bone?
Many thanks,
Meghan
Dr Arun Pal Singh Reply:
July 28th, 2010 at 5:03 pm
@Meghan,
Until I can have a look at the xrays, it is difficult for me to comment.
Dr Singh,
I’m just want to know how factor of age can be influencing healing process?
I hope Dr can help me to explain more detail.
Dr Arun Pal Singh Reply:
August 2nd, 2010 at 3:04 pm
@Leo,
With age the rate of healing slows down. If a child br4eakes the bone, it is almost sure to unite and in lesser time as compared to adult.
Similarly a young adult has higher chances of healing as compared to elderly person.
There is no quantitative measure for this as how would the bone healing behave in particular person at a particular age.
The reason is decrease in regenerative powers as we grow old.
I hope that helps.
Hello,
….. what can I do to get it right and ease this uncertainty, if a screw shifted wouldn’ t he know, and would he need to fix that, or is it the bone I feel……please any advice, would mean a lot. Thank you for your time.
I had foot surgury to correct a bunion (bunion was shaved and the shaft of my first metatarsal broken and re-aligned to correct the angel). My surgury was in the beginning of May, weeks later i was put in a walking black boot but still on crutches, then 1 month later when i went on June 25 (my next appointment) the bone at the shaft of my first metatarsal shifted a bit, Now on July 28 i went to see my doc, and he said its not healed, from what my foot doc says its not worse but its not better well on a day that my foot was not swollen i felt around the shaft of the bone area by my scar and feel a little round bump that moves a bit. Its tender in that area too. I have mentioned it to my doc but he says there is nothing he can do it just needs to heal so he told me take calcium and were looking into a bone stimulator, blah blah…
basically what I am wondering is is it possible that when the bone shifted a bit back in June so did a screw (I don’t even know if he put screws in my foot or pins or anything at all) if i do have screws/or pins is that the bump I’m feeling or is it the corner of the bone that’s shifted, that i can feel through the skin that’s caused a slight skin discoloration on that spot, and couldn’t my doc tell by the x-ray, if so why has he not elaborated any?
I’m just upset that i fell like I don’t know whats happening exactly with my foot…..I looked into a second opinion but everyone wants the records from my current foot doc and I don’t want to stir up anything or upset the doc by getting a sec opinion, i just want to know what that bump is and whats happening to the bone at the shaft area…. sigh
Dr Arun Pal Singh Reply:
August 8th, 2010 at 9:14 pm
@Beth,
No body can confirm as to what is that you feel untill one sees you and examines you.
I think only your treating doctor can answer your questions.
have a discussion with him.
i just got fractured in my right hand metacarpal(small finger). doctor adviced it is simple fracture . i am not having any pain. how long will it take to remove the cast in my hand . how long will it take to heal.
plss advice
Dr Arun Pal Singh Reply:
August 13th, 2010 at 3:57 pm
@ramesh,
Roughly 4 weeks if everything goes well.
Hi Dr. Arun,
Relative to my Jones Fx, though healed already but a bit out of position. Will bone still regrow and bring back the base of my 5th Metatarsal to its normal shape? From what I read about Jones Fx healing is slower due to poor blood supply in the area, isn’t it the tuberosity a spongy bone, thus, healing prognosis is quick?
Also, when I was given a go signal to go back to my normal activities, I immediately returned to running eager to regain my (leg) muscle strength.Doing so, I still feel superficial pain in the fractured site. Now, though trivial, my injured foot hasn’t been the same. My worry is, if I go back to mountain trekking, the pain might resurface despite utmost caution. Could strenuous activity as trekking trigger complications such as: arterial injury, complex regional pain syndrome and unacceptable chronic symptoms?
Thanks for your kind generosity,
Carol
Dr Arun Pal Singh Reply:
August 20th, 2010 at 10:39 pm
@Carol,
I am not sure if you are right about blood supply of the area being poor. Where did you read that?
Do not run or perform strenuous activities untill enough time has passed and these things should be increased in graduated manner.
Can you give me any idea of what the chances are that a 16 yo with open growth plates who has osteochondritis dissecans with a stable lesion of about 1.5 mm X 1.2 mm (no movement into the cartiledge) will heal without surgery?
Dr Arun Pal Singh Reply:
August 24th, 2010 at 9:30 am
@Armlock,
What is the site of the lesion? Usually they heal well without surgery.
Dr Arun Pal Singh Reply:
August 20th, 2010 at 10:39 pm
@Carol,
I am not sure if you are right about blood supply of the area being poor. Where did you read that?
Do not run or perform strenuous activities untill enough time has passed and these things should be increased in graduated manner.
******************************
Hi Dr. Arun,
regarding the low blood supply in the area of Jones fracture, I read it here :
http://www.foothealthfacts.org/Content.aspx?id=1416 and here…
http://www.podiatrynetwork.com/document_disorders.cfm?id=291 and here
http://www.sports-injury-info.com/question-broken-5th-metatarsal.html
thanks a lot for taking time shedding light into my concerns
)
God bless.
Carol
Dr Arun Pal Singh Reply:
August 28th, 2010 at 8:25 pm
@Carol,
Thanks for the sources Carol.
How are you now?
Dr Arun Pal Singh Reply:
August 28th, 2010 at 8:27 pm
@Carol,
Thanks for the resources.
How are you now?
Thank you, Dr. Singh. It is on his left leg, the lesion is on the anterior medial, femoral condyle.
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 5:45 am
@Armlock,
Given by the size, it should heal by itself. All the best.
Dr Arun Pal Singh Reply:
August 28th, 2010 at 8:27 pm
@Carol,
Thanks for the resources.
How are you now?
*********************************
You’re welcome Dr. Arun
I’m good. Two weeks ago I went on a day hike (minor) climb, on the way down there was a mild stretch at the front of the ankle that sent a quick pain signal other than that nothing bad happened. By Oct. (6th month from injury) I’m pondering if it would be safe then to join a major climb (multi-day) that would involve a great deal of backpacking load in a more strenuous terrain. Tendonitis is the only threat that makes me skeptical to sign up in the said climb.
For x-ray reference, you might want to check this. Over time, is it possible that the base of my 5th met. will return to its normal shape?
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 5:29 am
@Carol Villafuerte,
Your link does not work.
Dr Arun Pal Singh Reply:
September 2nd, 2010 at 5:29 am
@Carol Villafuerte,
Your link does not work.
****************************
sorry, here they are:
http://www.flickr.com/photos/carolskie007/4951083276/ and
http://www.flickr.com/photos/carolskie007/4951083272/
Regards,
Carol
hi…i suffered a fracture of the right clavicle 2 weeks ago and underwent figure of eght strapping and a sling. The fracture is healing well as of now. I am also on category 3 ATT for tubercular pleural effusion since the last 3 months. Could you tell me if the ATT is going to affect my fracture healing in any way?
Dr Arun Pal Singh Reply:
September 18th, 2010 at 6:38 am
@Dr. Raghav Chaudhary,
There is no evidence on that. ATT should not affect fracture healing.
talus fracture
My 12 year old son fractured his index finger 7 weeks ago. There is no bone growth occuring. What could be the possible reasons? We also had blood work done and his white blood cell count was 3.7, below normal and his mean platlet count was below normal too.
What could be going on?
Dr Arun Pal Singh Reply:
October 3rd, 2010 at 7:09 am
@Kathy Powers,
When did this injury occur?
What was the treatment taken?
What do you mean by no bone growth?
Were the counts done again?
Hi,
I am 28 yrs old and i suffered an accident on my bike 3 weeks back and reports showed displaced fragment shaft in the right tibia. The doctor had operated me within 3 hours of my accident and it was a 3 hour surgery where he inserted a rod from my knee till the ankle of the right leg.
I do not feel any pain in the leg still and also i am able to bend my knee easily. I am using a walker to walk daily and i do exercises told by my physiotherapist daily atleast thrice. Doctor has told that i cannot put pressure till 3 months from surgery. Could you let me know how long will this take to heal and when can i start walking properly.
Also when will i be able to walk on atleast a stick.
Thanks,
Rohit Sinha
Dr Arun Pal Singh Reply:
October 15th, 2010 at 11:43 am
@Rohit Sinha,
I think you are doing fine. Follow up with your doctor periodically who would be able to guide you better on your walking pattern and use of stick.
I sustained an impacted fracture of the medial neck of the talus 6 weeks ago… it looked like an avulsion on CT, as if someone took a bite out of the medial talar neck. It’s not too deep, perhaps 1/4 of the diameter of the neck, and I was treated with a boot since the fracture was “stable”, and had very little chance of avn, per my doc.
I was healing well at 4 weeks… shifting to an ankle brace around the house, using one crutch or a cane, when the physical therapist did an adjustment and acutely reinjured the fracture. She tightly gripped my ankle and her thumb dug into the fracture site while adjusting the location of the tibia and talus. My doc said it was overly aggressive “hands on” treatment but not to worry, it’s jut some inflammation and won’t cause long term problems with recovery, and recommended ice and rest.
That was two weeks ago and it’s still hurting even when I’m in the boot and gently push off the ball of my foot with two crutches. I’m think I’m doing all the right things… nutrition, rest, etc.
Does this still sound like inflammation, or would you think that the callus(?) or beginning matrix was actually disrupted… is there a way to tell? Would a bone scan or CT be helpful in guiding treatment at this point?
I am very concerned about malunion and other Cx.
For example, should I be icing still, or putting warm compresses on it to promote blood flow even though it could aggravate swelling…
Any thoughts you have would be greatly appreciated,
James
Dr Arun Pal Singh Reply:
November 4th, 2010 at 6:26 am
@james,
It is very difficult to disrupt a uniting bone after 4 weeks.
In any case an xray would tell you about the condition and position of bone.
If the pain persists, AVN should be ruled out.
Regarding icing or warming – the ice therapy is generally recommended in acute injury to reduce blood flow.
I think warm packs would soother you but you must first consult your doctor.
Hi,
I am 21 years old.I am from kerala.I am suffering from pain in my right hand thumb from last 1month.I fell down while i was playing.now the doctor adviced me to use the sling in that thumb.bt i can’t give rest to my thumb.Iam a Graphic designer.now i am afraid of this pain.some one wrote their comments ,that we may be do the surgery,if itz not corrected using this Sling.
Thanks
Sarath sp
Dr Arun Pal Singh Reply:
November 10th, 2010 at 10:37 pm
@Sarath s Pillai,
Please follow your doctor’s advice.
BTW how are you now?
I had a open fracture talus Hawkins III 6 month ago, now the bone is union,but I have necrosis in half of talus on X ray,I walk with one cruch,it is not painful when I walk.I also start do exercises for the ankle mobility.
What can I do in this situation?can I have chances to revascularizate the talus,after 2 years or something like that? or sooner or later I have to do arthrodesis?
I really want a opinion. I read a lot of this fracture,and all of them have a bad development like necrosis.I hope it will be ok,just God knows,I don’t know .
Thanck you very much
Dr Arun Pal Singh Reply:
November 14th, 2010 at 7:46 am
@Alexander,
Once necrosed, the bone would revascularize on its own, if it will.
The usual time mentioned in the literature is 25 -65 weeks for revascularization.
It is not necessary that AVN talus is painful and many a patients do well in spite of AVN.
However till the revascularization occurs, your foot needs to be protected.
Your physician must have explained that.
All the best.
why I don’t get an answer?
Dr Arun Pal Singh Reply:
November 14th, 2010 at 2:08 pm
@Alexander,
I think I have answered your query. Is there something else?
Thank you very very much Dr Arun Pal Singh. I am from Romania. And the doctors haven’t to much talus fracture and the don’t know how to manage them. I was non-weight bearing 4 months, then I was partiall weight bearing in a walking boot for 1 month and the I was off the cast and the walking boot and start kinetotherapy. My doctor didn’t told me how to protect the foot, he told me to start full weight – bearing, but I am scared and I am still in one crutch and walking with partiall weight-bearing on the foot, despite I don’t have any pain. Can you told me how to protect the foot and how can I do something for start early revascularization for the talus.I also have a poor mobility in the ankle,sometimes it swelling and it has a purple color,but it don’t bother me. Thanck you very much again from all my heart.
Dr Arun Pal Singh Reply:
November 27th, 2010 at 6:57 am
@Alexander,
Revascularisation is a natural process that would occur at its own pace.
Protection of the foot means not putting the weight on the limb.
The foot may need to be protected. It can be done by using a boot or a brace. Please avoid activities that produce impact n the foot. Use a stick on the affected side to share your weight.
All the best.
I fell and injured my right hip and I do believe the bursa sac is devoid of fluid for cushioning. the leg is very weak and i have to use a cane. would a cortisone injection into the sac resolve the problem? everyone else that has had the injection says it gives unbelievable relief for years and they can once again walk normal.
Dr Arun Pal Singh Reply:
November 27th, 2010 at 7:09 am
@Marlene,
Why do you believe so? Have you visited a doctor?
Hello Doctor,
I am a 19 yr old female and suffered a mildly displaced oblique fracture to the fifth metacarpal approximately 5 weeks ago. I was placed in a splint first then a cast. I just wanted a second opinion as to why it was not aligned back to its normal position because now I have a lack of a knuckle and trouble fully making a fist. Here is my x-ray reference:
[Ed:Info deleted for privacy issues]
I also recently had my cast removed after being in it for 4 weeks. However my doctor told me there was “minimal callous formation” and it was still moderately tender over the break told me and it was suggested that I get re-casted but I asked for a splint instead. I’ve read online that most metacarpal fractures are healed after 4-5 weeks. Does this type of fracture take longer to heal or should I be concerned? Thank you for your time.
Dr Arun Pal Singh Reply:
November 27th, 2010 at 12:57 pm
@Lola,
Some people take longer time than usual. In the given view, your fracture seems in god alignment.
All the best.
How long I must protect the foot?Till it appears on the x-ray the revascularization or just a year, since the accident it have past 6 months.
Thank you for your time,all the best.
Dr Arun Pal Singh Reply:
December 14th, 2010 at 2:53 pm
@Alexander,
There is no time frame. It is individualized. You need to protect till it revasularizes.
If it is does not do so for a year, it most likely would not.
My doctor told me that I was imobilized in the cast a very long period(5 months and 4 days) and he sad it is enough. He told me just to protect the foot with the crutch and to start kinetotherapy (to increase the mobility in the ankle) from 1 month and also 10 sesions of electrotherapy(for the Algoneurodystrophy symptom) .What is your opinion not to wear a boot and just to use a crutch?
Thank you for your time,all the best.
Dr Arun Pal Singh Reply:
December 14th, 2010 at 3:02 pm
@Alexander,
Talus is too damn slow bone. I would take maximum protection.
But as a patient you need to listen to your doctor. The advice he is giving you is more individualized and relevant.
I would always speak in generalizations because of the constraints involved.
Hello, in the 1974 i had a climbing accident whilst serving in marines i fell 30ft on to my feet and boke lots of different bones through out my body i was 21 then and very fit, now 57 and struggling.
i have had 4 (r) ankle joints and now fused
compound fracture of my (l) tib and fib
fracture to my (r) radius
fractured sternom
compressed fracture of my lower spine
8 broken ribs
but after all that its now taking it toll on me, the main problem now is my (l) leg its keeps swelling up around the calf area and becomes solid i get lots of pain with this and dark area apear on my leg and arevery painful to touch,iam also getting lots of pain from a bone in my foot ( cuboid ) i think its called its swollen and very painful.
would this be connected to my injury all thosr years ago? can you help with this problem
Dr Arun Pal Singh Reply:
December 15th, 2010 at 5:38 am
@LES CHADDERTON,
You should see a doctor in person and then reach at a diagnosis.
I can only provide you information on your condition but I cannot diagnose or treat a disease.
hola io me cai del techo hace 4 meses y me fracture la primera vertebra lumbar mi pregunta es podre hacer ejercicios o correr por que ya me desespero por hacer me estoy volviendo muy pansona jeje gracias doctor cuidece
Dr Arun Pal Singh Reply:
December 15th, 2010 at 5:47 am
@noelia, usted necesita ver a un médico. Su tratamiento y el pronóstico depende del tipo de lesión de su vértebra tiene asociada déficit neuronal
This is how my foot look after the accident,and after the operation. I was operated after 5 hours.
{Ed note:URLs edited for privacy issues}
Here is an X-ray after 13 weeks and after the second operation in which the doctor take off the pins and inject bone marrow from ilyac crest in the fracture site,because the fracture didn’t consolidate after this time.now after 7 months the bone is union but the avn is still present, After what did you see, what is your opinion? Can this big talus avn to revascularizate again in 1 year.
And if it will not revascularizate ,than talus will colapse and pain will appear and I must to do arthrodesis.
Excuse me from my insistence but I don’t have with nobody to talk. My Doctor don’t speak with me. Please understand me. I want to know my real chances.
If it will not revascularizate can I leave with this avn if talus will not collapse from my rest of my life?
I really don’t know what will happend with me, because I read a lot of article on internet and I think this is not good to me.
Thanck you very much, and all the best.
Dr Arun Pal Singh Reply:
December 21st, 2010 at 2:17 pm
@Alexander,
Have you the latest picture?
Can you send me all the pictures to contact [at] boneandspine [dot] com!
I would like to know the present situation. You submitted only 3 images and all of them were initial.
where is my comment? please answer me via email if you can answer on this forum
Dr Arun Pal Singh Reply:
December 21st, 2010 at 2:25 pm
@Alexander,
Which comment? I answered on today. Is there any more?
Please let me know.
I will make a new x-ray after a week and 7 months after the accident. I will send you immediatly,but with this initial x-ray how it is the situation? Excuse me from the last comment in which I sad “where is my commment?”, it’s a mistacke.
Thank you for your time.
Dr Arun Pal Singh Reply:
December 29th, 2010 at 12:25 pm
@Alexander,
More important is the latest xray. I would wait for that.
Its okay. Probably there was a delay in answering your comment.
This is the x-ray after 12 weeks [URL moderated]
This is the first x-ray after 7 months [URL moderated]
This is the second x-ray after 7 months [URL moderated]
It shows a little revascularization at the last x-ray?
Is there a sign of little revascularization at the last x-ray?
Is there a good difference between the x-ray at 12 weeks and the x-ray at 7 months,and not just the union of the bone,and also the sign of revascularization?
And after you see these x-ray can you tell me some advices,please.
All the best.
Dr Arun Pal Singh Reply:
January 12th, 2011 at 4:19 pm
@Alexander,
No! I cannot see any appreciable revascularisation as for as I can make from these xrays.
You need to continue the protection of the foot. All the best.
sir,i have fractured on little finger of right hand.docter tie up ball bandage for 11days then he tied my little finger with ring finger for 07 days,after this xrays show no result.please guide me to hill up soon.my age is 44 years.thanks
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 1:12 pm
@c.p.singh,
Can I have a look at the xray.
You can send them to contact [at] boneandspine [dot] com
Hello Doctor,
My husband is 9 weeks post injury – burst fracture of the T12 no neurological problems, he is still in a significant amount of pain when sitting up or standing, however he has low pain when lying down or walking is this usual? He is walking about 6 miles a day about 5 separate times – do you think it is ok for him to do this.
How long is it normally before he should be able to sit up for most of the day? He is 45 years old but has a significant gastrointestinal illness that he is trying to deal with as well. Will this slow down the healing?
I am having a hard time trying to keep him positive, he thinks he is doomed forever now.
Thanks,
Traci.
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 1:50 pm
@Traci Tunbridge,
9 weeks is kind of insufficient time for putting load on the spin. All the activities you describe load the spine, with sitting putting the maximum load.
Burst fracture is quiet severe injury. Body would take enough time to heal.
Recommended bed rest period is about 12 weeks.
At this point I can only tell you to wait and watch.
How much time I must to protect the foot?Till it will be a sign of revascularization?or until a year pass?
or after a year I can full weight bearing and if it will no pain,and no colapse ,it is ok,if not I have to do arthrodesis?
What can I do to help revascularization?
Thanck you very much.
Dr Arun Pal Singh Reply:
January 22nd, 2011 at 2:27 pm
@Alexander,
You can wait till one year from injury. If it has not happened by then, most likely it would not.
Further treatment would depend on your situation at that time.
Hello, had a fractured femur(left leg) on oct 9 2010, I did a surgery and a plates and screws were put to hold them together, fell like 4wks after and had the leg angulated.. Its exactly 3months after surgery and I haven’t been able to walk.. I am atimes scared ‘cos anytime I lift the leg up I feel movements in my leg.. I hope its not going to take a while to heal up..
Dr Arun Pal Singh Reply:
February 4th, 2011 at 7:18 am
@olaniyi taiwo,
OK.
What would you like to know?
What is the worst thing that could happened if it will not revascularizate.
Thanck you very much
Dr Arun Pal Singh Reply:
February 4th, 2011 at 7:28 am
@alexandru,
It can collapse but that would not necessarily mean you would have symptoms.
Symptoms would vary in different individuals.
i just recently had surgery on my right 4th metacarpal…..all my fingers move ok, except for my 4th i have trouble moving it back…..also my hands are swollen as well, and i can hardly make a fist. I just want to get back to work, and i am afraid my hand will never be the same.
Dr Arun Pal Singh Reply:
February 12th, 2011 at 8:52 am
@jaime gonzalez,
How much time has passed after surgery. Did you undertake physiotherapy exercises?
dear sir,
i m an ophthalmologist.i fall down before 6wk and my left hand scaphoid is fractured. i keep cast for 6wk but still there is doubt of non union.so i m very much confused that what to do?.here i take opinions from many orthopedics but there is contraversy.
so please give your expert comment
Dr Arun Pal Singh Reply:
February 12th, 2011 at 8:55 am
@Dr.Rupesh Mehta,
Can I have a look at the xray. Initial and latest.
Scaphoid fractures need to be in cast for 12 weeks.
But can I lose the leg from now on,or just I can make arthrodesis because of the pain?
Dr Arun Pal Singh Reply:
February 5th, 2011 at 12:52 pm
Loosing the leg is improbable because of the condition that we are discussing. The treatment would depend on your symptoms from wait and watch to arthrodesis in worst case.
Today is my birthday, I am 22 years old. If it will not collapse in 3 years it is impossible to happen?
After how long I could say I got rid of arthrodesis?
Thank you very much from all my heart because you are talking to me and help me.
I was afraid that I could lose the foot, but I understand that this is impossible after how much time,after 8 months and 11 days,because the foot has a normal colour,I have no infection and the muscle grow up.
I hope that talus it will revascularizate, because I have done much sports before and after the accident.
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 6:59 am
@alexandru,
Belated happy birthday.
Collapse is not sudden. It would occur over time if it does and a collapse does not result in symptoms in all individuals.
There is lot of difference between structural changes occurring in body and symptoms. There are so many individual variations.
All the best.
Dear Dr,
I would like to thank you from the bottom of my heart for all your help,
It has helped in many ways,
I would like to ask you, what would you recomend, as treatment, exercise, nutrition, and body weight
looking forward for you response
thank you for everything
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 7:06 am
@alexandru,
You can have a good diet rish in protein and calcium and try not to gain wait.
I think you are already under treatment. Consult your doctor for kinds of exercises you can do. This issue cannot be covered on this website, given the constraints of web.
And I also hear a little sound in the ankle when I make dorsiflexion and plantarflexion.Is this arthrosis? Is this a bad thing?It is no pain but it sound a little bit
Dr Arun Pal Singh Reply:
February 22nd, 2011 at 7:03 am
@alexandru,
Most likely it is snapping of the tendons. Should not be a concern.
Dr Singh
In your opinion does K-wiring accelerate the healing process in a left intra-articular comminuted distal radius and ulna styloid fracture?
I had my accident the 10th of january, and I’m due to return to the hospital the 15th of february (4 days)
I don’t feel much pain anymore (except that i believe my cast is swelling my hand), but i have read it takes normally 6 weeks for the healing…so my cast will basically be on one week less (and exactly one month after my pinning surgery.
Nothing i desire more right now than getting my cast and pins off, just worried it might be a bit earlier.
thanks a lot!
Dr Arun Pal Singh Reply:
February 12th, 2011 at 5:09 pm
@Andy,
K wire or plaster are not for accelerating the bone healing per se. Their function is to immoblize the fractured fragments in optimal position so as they get proper mileu.
One of the benefits of fixation by implant is early mobilisation of the neighboring joints so as their function is maintained.
And of course ability to repose displaced fractures.
But nothing is responsible for acceleration of healing.
Moreover, there is no hard line for 6 weeks. Generally speaking, the fracture takes between 4-6 weeks to show union but may take longer depending on the site and type of fracture.
But there is no rigid rule of 6 weeks.
Your treating doctor would evaluate you before taking any decision.
I hope that helps.
I have a burst/compression fracture of T12 from NOV 6th 2010. I have been undergoing physical therapy for about 5 weeks now and saw a lot of improvment with pain. I had a big weekend last weekend becuase I felt so normal. I did a few things around the house, got some trash out of the car including lifting the stroller and putting it in the garage. We went to the beach and I ran around with my 4 year old a little bit. The whole weekend I felt like the fracture never happend. Then Sunday evening came and my back and spine started to get sore. By the time I layed down that night I felt like I had gone back 3 weeks in recovery. It has been a week since then and it is a little better but still very sore. With 3.5 months of recovery time would running around on the beach and lifting a normal sized stroller for about 12 seconds re-fracture my back? The fracture was T-12 with 32% heighth loss. Some doc reports label it as a burst fracture and other ones label it as a compression fracture.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:28 pm
@Brandon,
It is too early to load your spine heavily. Please work on it gradually and be cautious.
Dear Dr,
when I make dorsiflexion and plantarflexion it sound a little bit the ankle. It is a friction on the side of the intern malleolus. 12 hours before it was no little pain and no sound. it is bone on bone,because it sound like bone on bone?
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:26 pm
@alexandru,
If it is troubling, please see your doctor.
my right finger suddenly shifted wat is d curse effect and cure
Dr Arun Pal Singh Reply:
March 8th, 2011 at 1:00 pm
@demmy,
It is not very clear from your information as to what has happened.
And it seems like an acute situation. Please see a doctor.
I appreciate your effort on educating the world on orthopaedics. Thanks, my God bless you all.
Dr Arun Pal Singh Reply:
March 8th, 2011 at 12:34 pm
@Aminu Ado,
Thank you. Your kind words are great inspiration.