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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@ Dr Arun Pal Singh
Thanks… I’ve been in my cast for five weeks…. I feel fine.
I have one more qeustion….
I’ve had my cast on for five weeks…. I have a full leg cast on (I can’t bend my leg, but i can my toes…) when i bend my toes (Espicially my little toe) i get a little sharp pain on the under side of where my ankle is…. would you know why this is….? Does this normaly happen?
Dr Arun Pal Singh Reply:
November 12th, 2009 at 12:54 pm
@Ashley M,
You would get better as progress with your physiotherapy. For your ankle stretching exercises would help. You can talk to your doctor about this.
hi Dr. Singh,
My 6 yr old son had a bone fracture in his arm between his wrist and the elbow 3 months ago he has been on cast for a month, the cast has been remove and healed but the bone didn’t connect properly and still dis align. Do you think it gonna be ok as he grows up? or do he need to go under surgery? and if he go under surgery can it be wait for another couple of years? because i can’t afford yet for now for no insurance and no income reason.
any help would really appreciated.
Dr Arun Pal Singh Reply:
November 12th, 2009 at 12:57 pm
@elsa,
I do not have a picture to look at so I cannot comment about the position. Fractures in children are very forgiving and realignment occurs with growth to quite an extent.
All these fratures demand is an acceptable alignment, not a perfect alignment.
If you wish you cab send me the picture and I could answer your question better.
i had compound fracture on my right humerus bone 4 weeks ago on a motorcycle accident. i got external fixation with 4 threaded pins. my arm still hurts until now, is this normal or is it otherwise? they said it hurts because my bone is healing. and i also have wrist drop how many weeks or months should i recover from my injury/wrist drop?
Dr Arun Pal Singh Reply:
November 12th, 2009 at 1:15 pm
@stevecatalan,
Pain is common complaint after fracture and can originate from many structures around the bone. B
Was your nerve explored or repaired. As it is an open injury, the nerve would have been damaged due to injury.
Your doctor would be better answering it as he would have seen the condition of the nerve and extent of injury.
I have seen your pictures and the trauma appears to be quit sever but I am not publishing the links for your privacy.
Thank you so much you are wonderful to help so many people with your knowledge.
You’ve answered my questions well, however a big concern to me is that I still very much want to have the plate removed even though you advise against it. Because I am small, very active, and I can feel a screw close to my skin at the dorsal end, I am afraid of physical activity with that in mind.
But also afraid about the surgery involved…. have been reading about nerve or artery damage/ complications or bone fracture during screw removal.
A friend had a broken radius (same as mine but not a Galeazzi fracture) 2 years ago. She had her plate removed after six months because the surgeon left the plastic positioning guides on the plate which he was supposed to remove at the time of implant. The reason for the quick removal was concern of infection from the plastic positioning guides.
How how could that have been accomplished and she healed just fine after ?
She was same age as me, 48.
Just curious if you have any further insight please.
Dr Arun Pal Singh Reply:
November 13th, 2009 at 11:51 am
@Susan,
In that case the risk involved was higher – infection as you suggested.
So the surgeon might have weighed that when considering removal.
But the recommended time for uneventful conditions is what already suggested.
In otherwise normal circumstances the risk involved is refracture.
SO it is better to let bone gather its maximum strength and the period taken is 18-24 months. Before that the bone is definitely weaker.
So removal is not recommended.
You may talk to your doctor when your fracture unites.
Thank you again Dr. Singh,
I will wait and hope for good healing and then maybe contact you again when I am ready to think about plate removal within the recommended time period.
Hi doc
No there was no ligament damage, just a break straight across the wrist, they did not tell me much else the doc just said it was a nice break. No xrays after and no physio they just gave me some exercises to do, it still swells at the side and clicks when I rotate it kind of a crunching noise although that does not hurt, it is still stiff though and hurts. is difficult to twist all way round. don’t know what else to tell you. Many thanks for the reply. I just want to know how long before it heals properly thanks again coral
Dr Arun Pal Singh Reply:
November 16th, 2009 at 12:40 pm
@coral,
With this much information, It becomes very difficult to answer your query. After a fracture has occurred, we need to know whether it has united. If the fracture was undisplaced, it almost always unites.
A fracture is also accompanied by soft tissue trauma and that might cause a problem for significant time.
If the problem persists I would advise you to see your doctor and discuss the issues.
Hi
moving to different subject although humans and animal are the same right?
My cat has broken his leg and have been wearing a cast for 6weeks now but it has not healed at all…..
he gets taken in every week to check for xrays if has healed but ived noticed that evrytime i bring him home his cast it not completely sealed although the drssing outside its change, i can feel an opening on both side of cast where vets needs to check for x-rays now my question if the cast should be completely sealed al the way through for the fracture to heal ???
Many Thanks
Dr Arun Pal Singh Reply:
November 16th, 2009 at 12:52 pm
@Tez,
First thing first. I am not an expert in vet science. Whatever I say would be based on experience with humans
A fracture usually shows some changes towards union in 6 weeks period.
I do not think I understood other part. What do you mean by outside dressing and sealing of the cast.
Is there a wound?
I got dynamization of upper two screws done one month back.Still the x-ray shows the gap between the two ends.The doctor says the clinical union has been achieved.
I am now in a dilemma how can a doctor say when the X-ray are same.(before and after dynamization)
Sir i will be very grateful if u can tell how can i differentiate between clinical and radiological union.
i had my surgery and nailing done on 12th may 2009 on right femur.its now 6 months.
at present i have no problms in walking nor any pain at fracture site.
Sir What should I do?
Dr Arun Pal Singh Reply:
November 16th, 2009 at 1:03 pm
@ajitendra,
A union is is just what it implies, union.
There is no differentiation as such in the literature between clinical and radiological union.
There are clinical signs of union and there are radiological signs of union.
First is seen by examining patient and second by looking at the xray of the part.
The clinician examines a patient and finds that union is probable.
And it is confirmed on xray.
But the ultimate verdict is always radiological presence of union because clinical signs may not be very reliable in all cases.
So for all practical purposes the union has to be confirmed on xray.
From your description alone I would say that you appear to have progressed well.
But if your xray says contrary, I would go with xray.
Just one thing. I hope you are not confusing a translucent line with gap.
Sometimes in spite of union a faint line can be observed on xray for a long time in some cases but that is unimportant if other signs of union are present.
But if a definite gap is present, it is not united yet.
Sir what is rod fatigue??
Dr Arun Pal Singh Reply:
November 16th, 2009 at 1:05 pm
@ajitendra,
The metal with repeated loading looses its strength at some point of time. This is called fatigue.
Hey, I’ve had my cast removed, My bone is fine! (I had a full leg cast, From my toes to just bellow my Groin) But when i go to bend my leg, it is really hard to-do (My first day out of cast) but then when i get a twitch my leg moves and it really hurts… I am crying and shouting.. But is this normal on first day (Will this get better even with out physiology?) or before i go? is there any exercises i can do before i go?
Dr Arun Pal Singh Reply:
November 21st, 2009 at 3:16 pm
@Ashley M,
After cast is removed the body would take some time to get back in shape.
Physiotherapy would help in that and is advisable.
@Dr Arun Pal Singh
So its completely normal for my toes to gor red, And if i tense (Like Tense) Its normal for it to hurt to?
Dr Arun Pal Singh Reply:
December 1st, 2009 at 8:47 am
@Ashley M,
If these problem persist I think you need to to see your treating doctor and ask him if it is something significant or trivial.
You would need to be seen and examined before your question can be answered.
hello doctor my pins are removed, what can you say about this xray photos?
[Ed. Note - Link deleted to safeguard privacy]
im on a fiberglass cast right now…
Dr Arun Pal Singh Reply:
December 1st, 2009 at 8:44 am
@stevecatalan,
The alignment looks fine. You need to wait for signs of union.
Good luck.
this is my xray 2 weeks ago, can you pls tell me if theres a callus formation?
[Ed notes URL-removed]
How long should i wait for signs of union? sometimes i feel wierd movements in my bone whenever i move my shoulder is this normal?
Dr Arun Pal Singh Reply:
December 7th, 2009 at 4:28 am
Union is a continuous process. There would be gradual improvement of symptoms as well as signs of union on xray.
This xray does not show callus.
A repeat xray after 2-3 weeks can show you if there is any progression.
Hi Dr. Singh,
I wrote to you about my Galleazzi fracture with plate and screws. It has now been about 13 weeks and still x-ray shows non-healing. I have no risk factors so why would this be ? My Dr, says “I don’t know – some bones just don’t heal’.
If at 6 months it’s still not healed then would this be a non-union necessitating bone graft surgery ?
I am waiting to see if insurance will approve a ‘bone stimulator’ which Dr. says I could try. What are your feelings on effectiveness of this device ? Do you know of anything else that could be a cause for not healing (placement of the internal fixture ?) or that could help in the healing process ? As I’ve said my Dr. is not good at communicating or answering my questions. I’m very frustrated and scared.
Susan
Dr Arun Pal Singh Reply:
December 15th, 2009 at 9:15 pm
@Susan,
It is often difficult to establish a cause of non union. You can go through this articles for list of causes
http://boneandspine.com/fractures-dislocations/complications-of-fracture-non-union/
Ultrasound bone stimulator has been shown to improve healing in tibial shaft fractures, distal end radius fractures and scaphoid fractures.
Not much data is available on shaft of radius fracture though. Because it is a non invasive method, I see no harm in trying it.
If your bone does not unite in spite of this, a bone grafting procedure would be required.
thank you so much doctor… can i ask you what are the symptoms should i feel this coming weeks? my doctor does not answer me right. he even said that there is a callus forming. what should i do and not do to prevent non union? please doctor i need your answer…
Dr Arun Pal Singh Reply:
December 15th, 2009 at 9:19 pm
@stevecatalan,
Decrease in pain and better control on your limb are the symptoms that may tell you that a bone is healing.
But the radiological confirmation is the final answer.
Serial xray examination should tell us if the union is occurring.
There is nothing active that you can do at this stage.
Let us see how does it turn out.
one month ago i fell off a roof and suffered a displaced closed midshaft fracture of my left humerus.
i was healing well with a hanging clamshell brace, but a week ago slipped on ice and reinjured it. the hand swelling and soreness had almost gone away, but now is way worse and the skin on the back of my hand is red and quite warm.
following the 2nd fall there is also significant pain in the area of the break, and i don’t recall much pain in that area before that.
they xrayed my arm and hand after that slip and said the hand was not broken.
what can i expect now and should i be alarmed at the hand pain and redness?
Dr Arun Pal Singh Reply:
December 15th, 2009 at 9:35 pm
@william stacy,
You seem to have complex regional pain syndrome or causalgia.
I do not have an article on this at my site. Meanwhile this would help you
http://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
Before jumping to any conclusion, you must get examined and get a diagnosis made.
Thanks so much for the info and link. it does seem to fit, so i’ll mention it on my next orthopedic visit. my hand does indeed from time to time have such exquisite touch sensitivity that its hard to do anything with it. the range of motion of my fingers is now very limited, but i’ll keep working them as much as possible as the article suggests. i wear an ace bandage now mostly to cover it from view, but the slight even pressure seems to help some as well. i’m an optometrist and don’t want to scare my patients. also taking norco and applying some topical cortisone. will post back after my next visit.
Sir,
I met with an accident and my thigh bone(Femure) was fracture in three pieces and i got treatment mailing at there. the accident was occurred at April 2008 and the bone is still minuet (little bit )growing in june 2009.So in Aug 2009 i met with bone grafting and the doctor has advice that not to bear weight on that leg so i do as per the doctor advice After 4 months now I m going to remove my bottom screws. the main point is that why my bone is not growing and what should i take for growth of my bone. I m taking the healthy food and from Aug-2009 medicines are : adlfo -2 tab a day, calcirol-week once,multivitegold -tab a day, previous i had taken the Gemfos=monthly once,1000mg of calcium 2 tab a day ,multivitamins a day,but when I change a doctor he advice me to no Gemfos in June 2009. and regularly milk also i m taking .
venkata prasad
Dr Arun Pal Singh Reply:
December 21st, 2009 at 10:10 pm
@Venkata Prasad,
Non unions cannot always be explained. There are so many factors involved.
Keep your diet healthy and follow your doctor’s advice. If the screw removal does not help you a bone grafting procedure is indicated.
Hope that helps.
update: i saw my orthopedist friday who diganosed mt swollen hand as an “impressive” hematoma. he had a trauma doc look at who concurred. my finger movement is slightly better and the pain is less, but the swelling is as bad as ever. i guess these clear VERY slowly, but i’m very happy it’s probably NOT CRPS!
as for the fracture, i too am not forming significant bone in the callus area. He says if still deficient in 3 wks he’s going to recommend surgery to pin the bones together. he’s kind of hoping that if i get more aggressive with using the arm/hand (instead of “guarding” it like i’ve been doing), it might help. agree?
Dr Arun Pal Singh Reply:
January 1st, 2010 at 4:08 pm
Yes! The motion does help by improving circulation and hastening the drainage.
Dear Dr. Singh.
Sir i’ve just frectured my 2nd,3rd & 4th t0e b0ne 0n the 20th dec…i would want to ask you how long a bone takes to heal and also will it hurt ?
nabila
Dr Arun Pal Singh Reply:
January 1st, 2010 at 4:19 pm
@nabila,
Fractures of metatarsal/phalanges should heal between 4-6 weeks.
Hi,
I fractured my t4 and t5 vertabrae on 9-19-09 in a 50mph dirtbike accident. I was hoping the back would have healed by now but I rode today and now the back has major tenderness in the fracture site. how long does it take to heal and how will I know its ok to ride again? thanks
Dr Arun Pal Singh Reply:
January 6th, 2010 at 11:25 am
@mahart,
I advise rest for 3 months to patients with spinal injuries followed by movement with a brace.
I would not suggest you to ride for next three months at least.
If your pain and tenderness persist after 4-6 weeks, get yourself reevaluated.
My son underwent surgery (Closed Reduction Interlock Nailing) for fracture both bone right leg following road traffic accident on 13 December 2009 for Grade I compound fracture. How long it will take for joining the gaps between the fractured bones?
Dr Arun Pal Singh Reply:
January 6th, 2010 at 11:30 am
@S Subramaniam,
6-12 weeks is the usual time for union. Compound fractures may take longer.
I have a 2-part proximal humerus fracture which occurred almost 3 weeks ago. At two weeks, a friend of mine lifted my arm and rebroke the bone (long story short, he is a resident 1st year and we saw this under a motion x-ray; of course, in retrospect, I shouldn’t have allowed him to examine me). Now, I can feel my arm “clicking” when I move my injured arm and can feel the two parts are separated, especially when I press the site of the break with my hand (of the other uninjured arm). I am worried that the re-break might result in a non union and am unsure whether I can fly overseas next week. Is this “clicking” sensation normal? Should I postpone my flight? Will my bone heal even though it was rebroken??? I am feeling extremely anxious; I hear this type of break requires 6-12 weeks of healing but now I’m worried I am not healing at all due to the re-break. I would greatly appreciate your professional advice. Thank you.
Dr Arun Pal Singh Reply:
January 12th, 2010 at 9:22 am
@jen,
Proximal humerus fractures rarely go into non unions. Most likely the fracture should unite.
Just get reexamined by a specialist to see if everything is okay.
With fracture one needs to give rest to the part. If you can manage that while you travel it is good.
I personally think that should take rest. Travels are not without hassles.
In the post-operation x-ray the fractured bones have been aligned properly with almost 99% perfection but in the x-ray taken on 05 Dec 10 there is a slight gap in the top portion but my son does not complain about any pain and is able to move the knee to the maximum. I shall be grateful if you could clarify that it would not lead to any complications at a later date. Now he has been asked to take GEMITROL – one daily for fifteen days. Now my son is walking with a walker. When my son perform wait bearing exercises without aggravating the surgery already done?
Dr Arun Pal Singh Reply:
January 12th, 2010 at 9:29 am
@S Subramaniam,
I think your treating doctor is in better position to answer these questions. Detailed patient information and examination findings are necessy to answer your questions.
Dr. Singh,
One of my family members injured their back – burst fracture at the T5 with three broken ribs around that area. I’m very concerned as I do not know how the spine heals from something like that. I’ve read how traditional bones heal in the rest of the body but I know the spine is different. It’s hard to get clear answers and what they’ve been told is that it will stay spongy and bone will heal around the injury with some spurring. They have been wearing a brace for 12 weeks. Can you please tell me how long it takes for the spine to heal from a T5 burst injury, exactly how it will heal, and what the lifetime limitations and effects are from an injury like that? They are an older adult who has been all their life otherwise physically healthy. It would put my mind at ease to know what they can expect in this healing process. Thank you so very much for your time.
Dr Arun Pal Singh Reply:
January 12th, 2010 at 9:49 am
@Elle Farraday,
The spine usually heals enough by 12 weeks to begin mobilization with brace. A further use of brace is controversial. Some authors suggest that it should be borne or 9-12 months while others refute this entirely.
Spine heals like other bones and only follow up will show what would be the outcome.
You did not mention if there was an associated neurological deficit [loss of motor power or sensations]
That would change the picture. Burst fractures at this level are usually associated with neurl injury too.
If there is no neurological loss as you should expect good healing by now.
back pain is the most frequent complaint in these patients in the long run.
Dr Arun, I am doing Residency in Ortho,1st year. My thesis requires that we determine the healing of fracture after surgery, during Follow ups at 1, 2, 3 and 6 month intervals. Now how do we determine this objectively-clinically as well as radiographically(simple X ray films), esp. the latter.
Will appreciate any help.
Thanks.
Dr Arun Pal Singh Reply:
January 19th, 2010 at 9:37 am
@Dr S Singh,
Congratulations and welcome to the fraternity. For your query, you would need to dig the literature on subjects of bone healing.
I assume you would already be aware about the subject and under your supervisor you would be able to find what you are looking for.
My answers can only suggest you but you would need to reference the methods as well. Therefore it is better to look up the matter yourself.
There is plenty of material available in form of text books and journals.
BTW, where are you pursuing your course?
I have a tibial fracture and it occurred on 21 November 2009. I am on plaster and the problem is that the X Rays show the bones not aligned I would like to know how long will union take place or will require surgery.
Dr Arun Pal Singh Reply:
January 19th, 2010 at 9:47 am
@luke,
That depends on a lot of factors including type of injury, fracture configuration etc.
Usually by this time the signs suggesting union should appear.
You can talk to your treating doctor on matter of union and alignment.
I think it is time if any alteration in the treatment is to be contemplated.
Hi Dr. Arun,
Wishing you a very Happy New Year 2010. Below is my last post and your reply:
My question is that I still have pain in both my wrists, I have started going to gym again but am unable to pick up weights. Till when will the pain be there?
Regards,
Sam
**********************************************************************************************
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 Pal Singh Reply:
January 22nd, 2010 at 9:53 pm
@Sam,
If you syill have problems and things are not improving, get a wrist examination and if needed an investigation to rule out soft tissue injury.
Did you talk to your doctor?
What did you discuss?
Dear Dr. S,
I have the Galleazzi fracture with plate and screws that is very slow to non-healing.
My doctor says that it is a race to see whch happens first…. the bone heals or the plate breaks.
I am very disturbed by this analogy and am wondering if you have ever heard it before. It just doesn’t seem right .
I have been using the electric bone stimulator for a little over a week now. You mentioned that the ultrasonic device has shown some effectiveness but what about the electric one ?
Also I bought a bone supplement called “Bone-up” with vitamin K in it in addition to taking daily calcium and vitamin D pills. Do you think these help ?
Dr Arun Pal Singh Reply:
January 22nd, 2010 at 10:16 pm
@Susan,
When your doctor says that, he/she is talking about implant failure. I have slightly touched this issue in this article
http://boneandspine.com/fractures-dislocations/humerus-fractures/fracture-humerus-fixed-plates-and-screws-with-radiological-signs-of-implant-loosening/
I think, in your case it is important to decide if it is healing slowly or not healing at all.
In latter case you would need a kind of surgical procedure and it is prudent to do that within reasonable period.
If it is slow union [called delayed union in medical terminology], then your bone should heal albeit slowly.
I do not think vitamin and mineral supplement would have effect on union, until you have deficiency which normally a person of average built and duration does not have.
Thank you Dr. A,
I went to your article and also the related ones and I find them so fascinating but only hope that further surgery will not apply to me.
How long can delayed union go on ?
I know that technically after 6 months it is considered non-union, but my Dr. says that some people possibly can take much longer and slower to heal (up to and after 12 months).
Hence the race annalogy.
What would determine whether or when surgery is necessary ? I do not have pain but twinges sometimes especially if i use the arm with pressure (opening jars, pulling on boots…). I try not to push it too hard or lift anything more than 5 pounds.
I will try tofigure out how to send you an x-ray.
A couple more questions please if you don’t mind…..
!) What do you think of the bone-growth stimulator that I mentioned I’m using ?
2) If bone-graft surgery were needed, I’ve heard that the bone tissue can be taken from the same bone –
is that true ? My Dr. mentioned it would be from the hip.
3) Could you explain a bit more about these reasons that you listed as causes of non-unions,
especially the last two :
– Inadequate immobilization
– Distraction at the fracture site resulting in a gap between fractured surfaces
– Energy of the injury
Thank you once again,
Susan
Dr Arun Pal Singh Reply:
January 28th, 2010 at 7:35 am
@Susan,
Ther is no fixed time frame for delayed union. If a fracture healing activity is occurring slowly, it is labeled as delayed union.
If there is a progressive changes albeit slow, a fracture can be expected to join.
1) I have no experience with bone growth stimulators. What I had told you was from literature.
2) Usually the bone graft is taken from ilium bone, a bone in the pelvis as you mentioned it. Graft from the same bone is used when only small quantity is required.
And in non union, one always uses copious graft.
3)Inadequate immobilization
This mostly applies to patients treated with poorly applied plasters and traction. In modren orthopedics, this as a cause is reducing.
Distraction at the fracture site resulting in a gap between fractured surfaces
If there is a large gap between the bone ends they would fail to unite.
Energy of the injury
If initial injury disrupts vascular supply due to impact or damages soft tissues around the bone, chances of sound healing become less.
i hv a fracture and have a gap of almost 2 cm, my query is will bone gets union in certain time frame or grafting is the only option.
Dr Arun Pal Singh Reply:
January 26th, 2010 at 10:09 am
@yogesh,
Is it really 2CM or it was a typo.
2 cm gap would not unite in any case until it is reduced.
As per the doctors its approx 2cm and now they are planning to hv grafting and implant.
Dr Arun Pal Singh Reply:
January 28th, 2010 at 7:44 am
@yogesh,
Then, you appear to be treated rightly. The primary aim is to reduce the gap and stimulate bone healing by grafting.
I fractured my left humerous a while ago, i got surgery, a metal plate with 9 screws.
i lost movement of my thumb and index finger and im slowely recovering my movement. i think the surgery damaged my nerves or something. my skin started falling off after taking a shower or wshing my hands in those two fingers.
right now i can move my fingers better but they are still numb and its been 5 months already. i also feel my skin very humid or sweaty on my fingers. My skin dosent fall off anymore but the underside of my finger tips look like raisins after coming in contact with water in a relatively short period of time.
What is happening to me
?
Will i be able to feel my fingers again?
Do i have to remove the metal plate and te screws when im older to avoid these problems?
Will my humerous be weaker or stronger with a metal plate? (might be weaker because of all the screws maybe?)
Dr Arun Pal Singh Reply:
January 29th, 2010 at 9:10 am
@Roberto Nelson,
What nerve was involved?
What is your age now?
Has your fracture united.
Plate should be removed only after 18-24 months.
Humerus is not weak with plates but it is susceptible to get a re-fracture for initial few weeks when plate is removed.
My doctor said my internal plate could stay there for the rest of my life if i didnt feel any discomfort. The bone did unite. I dont know what nerve is involed im just speculating. I am 20 years old.
All i know is that if i lift my fractured arm perpedicular to my standing body with my palm down. and then i tap the underside of my elbow area with my other hand, i feel a weird tingle throughout my whole arm all the way to my 2 fingers.
It feels like when one wakes up from sleep and a part of the body is numb because blood circulation was interrupted due to too much body weight on it.
my doctor said the it was due to the effects of morphine which would were off slowly. then another doctor told me to wait it out, that it was probably a damaged nerve from the fracture.
But when i had my bone broaken i could move my fingers with no problem, it wasnt until after the surgery that i started having difficulty moving them.
I have theorised that maybe one of the screws they put in my bone is going too deep into the bone or something and that maybe that is causing me problems (i dont know though, i might be making stuff up). When i saw the X ray, i noticed the screws are a little too big for my bone; they went in more than halfway into the bone’s width.
Heres a link to my X ray. (i dont have the one with the plate and screws on my computer)
Note: The link deleted.
Dr Arun Pal Singh Reply:
February 4th, 2010 at 1:00 pm
@Roberto Nelson,
I have looked at the xray and the fracture is at a place where radial nerve is very vulnerable to injury.
If it was intact in the beginning as you suggest, it is very vulnerable to manipulation.
Without looking at xray with implant, I cannot comment on screw as a probable cause.
But there are higher chances of nerve getting injured in perioperative period than due to scre irritation.
I recommend you to visit the doctor and get yourself examined. What you describe as tingling sensation appears to be attempt of nerve to regenerate.
You can get investigated for nerve studies and we would be wiser.
I hope that helps.
hi Dr Arun,
I am 26 yrs male and had fractured my distal humerous fracture (right hand) a month ago doing arm wrestle.
The fracture is oblique spiral and displaced. The doctor has decided to treat me conservatively i.e. by hanging cast. The treatment started after one week of the incident during that period I was in the backslab.
X rays after first week of hanging cast showed that bones are slightly in contact but doctor adjusted the cast position for better alignment and set the reappointment after two weeks.
Now two weeks are about to complete and I am feeling no pain at fracture site and some strength in the bicep and triceps area.
Are these indications that bone is healing ?
What are the general feelings of patient when bone is healing apart from x-rays ?
Thanks for your advice.
Dr Arun Pal Singh Reply:
February 8th, 2010 at 6:12 pm
@Fahad,
They could be but it cannot be said for sure.
Only confirmed way is to look for clinical signs and xray.
My 13-year-old daughter fractured her middle and ring finger knuckles on her left hand playing basketball. She always kept the splints on, but remained active in basketball practices as well as volleyball practices, just not setting the ball or spiking with her left. She was able to do about everything else. Her 2 week follow-up xray showed “no new bone growth”. Her pediatrician figures this is because of so much activity, the vibrations not letting the bones heal. She is again wearing the splints and will go again in 2 weeks for another xray. She is not participating in any sports at this time. Do you think that activity like that would be the cause of her delayed healing, or could we be looking another problem? Thank you.
Dr Arun Pal Singh Reply:
February 18th, 2010 at 2:37 pm
@B. PEARSON,
Inadequate immobilization can lead to delay in healing. Only way to tell if we have another problem is to first provide adequate immobilisation.
Hello Doctor
I had a fall on Jan 4th with a fracture on my right foot toe bone and a ligament tear on the finger next to the toe.. I was in cast for 3 weeks and now I just have a Plaster. I stopped taking painkillers post a week as I really did not experience too much pain post the intial day when i fell and it was swollen. Now after 6 weeks i have having a poking pain in the exact spot of broken bone (toe).. Can i take it that its healing? Does it prick a little when its on its way to healing? I get this pain on and off. I am able to walk now on flat surface but also want to know when I can start driving safely?
Dr Arun Pal Singh Reply:
February 18th, 2010 at 2:47 pm
@Radhika,
I think your treating doctor would be in better position to answer your question.
The healing can only be confirmed by xray. Other parameters are subjective and reliability is less.
i have posted about my displaced humerus mid shaft fracture nov 1 that we tried to fix with a clamshell brace but i fell again on some black ice dec 15 and reinjured it; not sure if that 2nd fall caused the non-union but we threw in the towel jan 15 and had a compression plate placed under the triceps which the surgeon says should stay in forever (i’m 66).
i’m still taking pain meds, but down to 2 or 3 norco 10’s per day mostly due to difficulty sleeping with the discomfort, but also some dull aching during the day that wears on me (i’m still practicing optometry full time). Or partly it may be a bit of addiction? Anyway, am i ok to continue this for a while, or should i work harder at weaning off of them?
also, my range of movements and strength are improving, but i have 2 areas i cannot do much in at all. i cannot reach around my back and put the belt through the loop with my left hand, and i cannot quite reach my right armpit with my left hand when showering. that seems like it’s more a shoulder restriction or what? are there some exercises i can use to improve that range of motion?
finally, i’m curious about a patch of numbness just on the left bicep, about the size of a coffee cup base. how long if not for ever will that last? my followup visit is not for a couple more weeks.
p.s. my hand hematoma swelling finally went pretty much away, although my middle and ring finger are still pretty tight and a bit uncomfortable when pushed into full flexion.
Dr Arun Pal Singh Reply:
February 24th, 2010 at 9:49 am
@william stacy,
Things look better than what you posted last time. You seem to have stiffness of shoulder and hand joints. They should go with physiotherapy and range of motion exercises.
For hand compressing a tennis ball or gripper can help you to regain the strength and range of motion.
Shoulder exercises should be begun inn consultation with your doctor.
The numb patch should go away with time. It usually does.
My mom fell and broke her humerous seven days ago. She went to the ER and was admitted to the hospital. They said it was a straight break in the lower part but then spiraled and shattered toward the top. They originally said it would need surgery and a rod. Contributing factors are her age (75), weight (275 lbs.), diabetes and her white cell count is high, indicating an infection.
It has been seven days and she is still laying there with no surgery, sling or immobilization.
Today they were going to transfer her to another hospital. We are now told the new hospital has refused to take her, after they had agreed.
My main concern and question is “What will happen to the healing process of the bone with this much time passing and no treatment?”
We don’t want them to just do anything but we want to understand what is going to happen. Is there anything we should stop them from doing?
Any information and direction is appreciated. Thank you.
Dr Arun Pal Singh Reply:
February 24th, 2010 at 9:56 am
@Lora,
The first thing any patient should have after a fracture and while one waits for a definitive treatment , is the splintage. I think her arm would be splinted.
Definitive treatment is not done on the urgent basis and technically a delay 1-2 weeks should not cause much change in the final outlook. The only problem in the waiting is the discomfort that patient suffers.
I am sorry for delay in writing back. I think you needed an answer sooner. But I was quite occupied.
How are the things now?
Hi Arun,
thanks for your reply.
now doctor has removed the hanging cast after doing clinical evaluation and x rays and replaced it with u -slab for 4 weeks. callus was very visible on the x rays.
i think there is more likely hood than not that bone will heal. what are risks you see ?
thanks
Fahad
Dr Arun Pal Singh Reply:
February 24th, 2010 at 10:02 am
@Fahad,
Callus itself is a good sign. All the best.
Thank you for your reply.
I don’t know why they didn’t splint the arm. It is incredibly swollen, black and purple. She has been very uncomfortable and is on Delottie every two hours or as needed. It has now been 13 days.
The possible good news is that her white count is down and they will be doing surgery in the morning. The first option will be to insert a rod and if that is not possible because of the bone fragments then it will be plated.
We will know more after the surgery and I am sure have many more questions about the rehab.
Thank you again,
Lora
i have fracture of coronoid process. can this heal without surgery? i have some range of motion and no dislocation. Doc has res split and sling for 10 days, then re-eval. Common?
Dr Arun Pal Singh Reply:
March 3rd, 2010 at 12:49 am
@jay,
Coronoid fracuteres are also treated non surgically when the fragment is small enough.
I think you would be benefited by talking to your treating doctor
i fell from a table and got my ulna bone fractured (vertically) and doctor advised me for 2 weeks plaster then extended to 3 weeks then told me came to me when u will not feel any pain and further said u can do ur office work too. i m 30 years old male so tell me how much time it will take to heal it thanks.
Dr Arun Pal Singh Reply:
March 3rd, 2010 at 12:52 am
@rinku,
A fracture takes from 8-12 weeks to heal.
My 13 year old son broke his arm 15 weeks ago. He had one clean break the radius and a fracture on the ulna. He was taken out of his cast the second time around, but the Doc said it was still not healed so put him in a splint..now today he went in 15 weeks later and the Doc said it was still not healed come back in 6 weeks, but in the mean time leave the splint off and no sports or p.e in school. Is there something more serious wrong with my son that this is taken so long? Do bones sometimes just heal slower in some people for no reason than just being slow?
Dr Arun Pal Singh Reply:
March 17th, 2010 at 8:32 pm
@jenna,
Delayed healing is a known phenomenon but 15 weeks is quite a substantial time for both of these bones to unite at this age.
What I can think of is that some of these children behave like adult bones which show poor response with non operative treatment.
In any case if the bones fail to unite only option left is fixation and bone grafting.
You can discuss with the treating doctor
Thx Doctor. sir can u tell me i am having swelling on my wrist and it feels little pain when i move my wrist and i cannot move propoerly my wrist and tell me what precautions i have to take from now can i ride a bike or drive a car and so on thx.
Dr Arun Pal Singh Reply:
March 17th, 2010 at 8:40 pm
@rinku,
Please discuss it with your doctor if you can be allowed to do these activities.
Just take care that for few months a lesser trauma can cause the fracture in the healed bone as it does not achieve strength in spite of union.
You might have an additional injury in the wrist. You can get it examined. If xrays are normal and your pain and swelling does not go, MRI can help
I have a 3-part proximal humerus fracture. XRays today, 12 days after break, show fair alignment (not perfect), surgery not indicated, ortho told me if it was him he would not operate. My question is I am supposed to run a marathon 7 weeks after break- that is full 26 miles (42 km). If I have a fairly good union at that time I should be OK to run- I hope. Is it possible to start running earlier? Docs tell me to stick to stationary bike for first 4 weeks. And as I’m sure you know, I am only in a sling, and it can be hard to keep the arm immobile. FYI the ortho characterized my fracture as “significant”- the neck broke completely across with the top outer part of the joint splitting off. It is that outer part that does not seem to be aligned so well- the main shaft and top of joint appear well set for union. Also, I am 48.
Thanks.