Healing of a fractured bone is quite a complex process.
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 hematoma 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 abscesses) .
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 vessels 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 structure 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 found 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.
Hi, my daughter 14 14 months old, she fell whilst trying to walk and immediatley started crying she was taken to AE who sent her home, she was taken back and xrayed where she had fractured her right arm mid length. A cast was applied. Visted follow up appointment cast removed, no xrays bar looking at her arm, prior to the cast she could move her arm etc is this normal practice, do not feel 6 DAYS is long enough to heal a FRACTURE not sure what to do next, PLEASE help.
@Sarah NEARY,
You are right. Six days is not enough time. Can I see the image.
Would you 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.
Hi please can you advise me in relation to my daughter. My daughter is 14months old she has recently fallen and was taken through to A/E who discharged her without xraying, she was taken back and xrayed where she had 2 fractures to her right arm. The arm was put in to a cast. 6 days later follow up appointment and DR removed cast. 6 DAYS does not appear long enough to heal a fracture, spoke with him who stated that she was moving her arm, however pointed out to him she was moving arm prior to the cast put on and that she is receiving pain relief. I am really not happy about the cast being removed, not sure what to do next PLEASE advise.
@S Neary,
Please see the previous answer.
Hi, I broke my humerus mid section 6 weeks ago and at the 4 week mark I started doing exercises. I have a humerus brace and tensor bandage for forearm (optional at this point). Now, I've been taking the brace off during the day to bath and do exercises and leaving it off during the day. Is this a bad idea? I'm usually sitting down and do minimal walking around. I put it back to sleep and with the tensor.
@Lee,
If it is being done under the advice of your treating doctor, it could be okay.
Decisions about your arm should come from him/her not some third person.
Hi Dr.
I was reading your article as being interested in knowing more about bone fracture.
I had a severe femur fracture, and under gone surgery inserting a rod through all the bone with two screws at the top another two screws on the bottom side of the bone. Doctors were satisfied with surgery and just asked me to give time for recovery and healing.
It is a little frustrating to know when I can walk again; the x-rays are horrible, the gaps are huge and fracture is scary. Do you think you can have a look at it and estimate a progress time to heal? It is impotant that I know when can I run again.
Accident was also puzzling; I was playing rugby, and broke it while simply running hard, doctors said that my bone is healthy I shouldn't be worried and I was just unlucky. I can't believe a hard run would break this particular bone. Can I ask for your advice in email? Your response is very much appreciated!
@Gilbert,
Would you please ask the query at boneandspine.net. It is our forum and you would be able to upload images as well and It would be easy for me to have a look.
Thank you doctor.
I have registered as Gilbert in boneandspine.net and created and entry 'femur fracture'
Not sure if you can see it or how to get you to see it.
I hope I get a feedback from you. If there should be another way to do this, please let me know.
Regards
I have answered your query. You may view and follow it here
http://boneandspine.net/showthread.php?10-Femur-Fracture-Gilbert
MY DAUGHTER FRACTURED HER LEG WHEN SHE WAS ABOUT 18 MONTHS OLD SHE IS NOW 4 YEARS OLD IS IT POSSIBLE THAT THE OLD INJURY CAN STILL SHOW UP AS A FRACTURE ON AN MRI OR CAN IT BE A NEW INJURY OR POSSIBLY THE SAME OLD INJURT THAT NEVER HEALED??
@SHEREA MALCOLM,
Why MRI? Xray is much better modality. If there is no h/o fresh injury it would be sign of previous injury.
Healing is a rule in children and if the child has no symptoms, I do not think there is a cause for concern for old injury.
BTW, Why was an MRI done?
please help with this surgery had surgery for fractured ulna with plate and 8 screws . one end is healing and the other one is not healing it has been since june the 30 any idea why dr . can't seem to know . i really am trying to avoid another surgery thanks
@alice brooks,
I need to see the image.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.
Hello Doctor,
I started playing badminton recently after 12 years and I surely overdid it. Now for last 1 and a half week I have pain (really bad pain) just below my knee and above my ankle. I am unable to walk and climb stairs also. There is too much pain and sometimes it is really unbearable. The knee also seems to be unstable. Please help what it can be and how can it be cured. I am having pain killers.
Regards,
Sam
@Sam,
Please see a doctor who can examine and advise you in person.
Goodday Dr.
I've fractured my femoral shaft 4 consecutive times & dis happened wen i was aged 6-9yrs. I am now 19yrs old. After undergoing several surgeries, i ended up wt bow legs, my left leg is now longer than my right & my left hip is very protruded while my right hip is as straight as a metre rule. Often times i get severe sharp pains in my knees & sometimes in my left hip. Whenever this happens, i find it hard walking. That's not all, i can't walk fast,walk or stand for long, run, carry heavy load or do any form of exercise that requires me putting pressure on my legs. My thighs and legs are always fatigued. I don't limp even though my left leg is longer than my right. I discovered that if i lifted my right leg some few distance from the ground, both hips would be equal. Mind u, my right leg is now shorter & bower than my left. I'm not a doctor but from my own deduction , my right is bower because it touches the ground otherwise i should have a limp. I've been to my doctor but i couldn't get any result.
I know this is very lengthy but please what do you think because i feel very miserable.
@Joyce,
Sorry for the delay in replying. There is a lot of information that you are trying to squeeze in few sentences and I am not able to make much.
Would you please elaborate. Never mind the length.
I met with an accident 5 months( i.e., Aug 2011 ) back and i had a compound fracture of right humerus upper middel 1/3 junction. I have undergone orthopeadic surgury by inplanting a rod on the same day.
Even after 5 months it is not healed completly. How long does it take heal completly ???
@sagar c,
Can I see your xrays. If it has not united by now it should most likely be non union.
Dear sir,
My right leg tibia and febula was fractured on 6th of january 2012, doctor did surgery on 10th january 2012, he inserted the long rod and two screws, for febula the kept one plate, pls advise me when can i walk, i want to do my professional job quickly
krish…
@narender,
The best person to answer this is your treating doctor. But generally speaking if your fibula needed fixation, you would need to keep limb off the ground for average 8-12 weeks.
Hi Dr,
I fractured my mid spine last week, i was only told that it was a verterbra or something like that, i dont know what to do, i was given pain killers and thats it. I feel as though all my pain has gone to my right side of my back and going down my side. I also experience like a nerve or vein pulling in my left temple area and ive also been feeling really light headed and just been making silly mistakes in anything i do now. Do you think this is related to the fall i had that caused the fracture or something else and also i dont know which side to sleep on or how to sit etc. im sorry i know this alot but please can you help me.
@Jenny,
I do not think my answer would be relevant. It is phenomenally delayed. And I apologize for the delay.
How are things?
Oh and i forgot to mention the doctors said that my rib cage was keeping the fracture stable so im lucky? And how long will it take till i can move around however i want or in other words when will my back fully heal. Thank you so much.
Jenny
My mother is 67 yr old , she slipt in bathroom , she is suffring from back pain we got X – ray one dr. asked to admit my mother for 7 days in his hospital, he said there is fracture in backbone . But i m not bleaving because my mother is walking with some suppport.Pls tell is this possible to walk with some fracture in backbone.
@PANKAJ,
Not to trust a qualified opinion based on prefixed assumptions may be counterproductive.
You must take another opinion and confirm.
Hi sir my mother got humorous fracture in the month of november2010 and she got operated and a shaft is fixed but no calcus formation after three months of operation when we taken out the xray. then we went for auyurvedic medicine for six month then again we have taken out x ray then only 5 % of calcus growth has seen affter that now i have taken a x ray what it showing i m not able to understand so kind tell what is the position after seeing the xray so how should i must post the xray to u pls reply asap
@Rishabh,
You can send the xray on contact [at] boneandspine.com
sir, i fell from the scooter 6 months ago and suffered lateral tibial plateu fracture with depression around 4 mm.. also had lcl injury ..did not have any surgery. also had a history of pcl injury 4 yrs ago..i m not able to bend knee more than 90deg ;; also have pain and swelling,almost been on bed for past 6 months.. how long does healing take?. and wat shud i do to recover fast?
@sanjana,
I think you need to work on physiotherapy of your knee. Get in touch with your doctor and follow the advice please.
ps- sir i forgot to mention above that i am 26yr old female
sir,
my father had an accident 2 months ago against a truck in eastern ghats.
The accident lead to a seviour fracture in leg and rod has been inserted .
Bt 2 months had passed bt there is nt even a single percent in relief frm pain..
HE IS A SUGAR PATIENT and its becomin vry tough fr him to control d pain..
Lukng at d other posts i thnk u wuld be needed to luk at d xrays n al.. Bt problem is im stayin in hostel n preparng fr forth comng entrance so even i had nt met my dad. Since i am nt in hom so i cnt send u ny xray.
Sir u pls jus
Say dat accordng to u isnt it unhealthy to listen 2 months passed n no betterment..
Can u estimate if everythng is alryte in leg den atleast hw many months it wl tak to recover…
@trimod,
It is an unsual thing have the same quantity of pain even after two months following fracture.
Please discuss with your doctor and ask the questions so that you get better answers.
hi Dr Arun. nice to meet you! My dad fell down when he is working on friday which is few days ago. From the x-ray, we found that the T-12 and L-2 fracture. So, doctor in charge recommends putting screws on the T-12 and L-2 (5-6 screws are needed).The recovery will be much faster compared to letting the bone healing on its own. What i concern is the long term side effects after putting the screws? i was informed that he can't bent down his back after that. may i know to what extend he can't bend his neck? Will he feel pain or whatever after that? how long will he take for full recovery?
@Helen Theng,
There is no relation between the T12-L2 surgery and neck movements. Moreover even the bending of lower back would not affect the daily routine.
Recovery may take from 3-6 months.
what do you think about playing badminton 2 and a half months after breaking my wrist(just above my wrist)? is it a bad idea?
@TY,
That would depend on your injury and how it has behaved. Follow what your treating says.
sir i have fractured my fifth metacarpal of right hand. My doctor has applied a plaster/case. Will there be any problem in healing? Is perfomance of normal movement possible after healing?
@Jigar patel,
I do not have the required info to answer the query. Please ask the qustions to your treating doctor.
Dear Dr. Arun,
Please assist me, my mother is 90 years old. She fell down one early morning, after having a black out and fractured her right neck of femur. She was adimitted in hospital, whereby it was confirmed fractured of right neck of femur, in different positions AP, Lateral, Oblique view. The orthopaedic surgeon with a team of physician counselled us that the risk of ORIF with aritificial head of femur in her case outweighs the outcome intra operation and post op. She was transfused 3 units of blood. Skin traction was not recommended as she was vulnarable to skin ischaemic changes, Due to severe pains she is on tramadol 100 mg TDS daily, Fessolate 1 twice daily and amlodopine 2.5 mg daily. She got discharged and we are nursing her at home. I observed that the right thigh is swollen and tender, the right lower limb is shorten and deviates lateraly, Mobilising her on bed is very painful. My family is so worried and very concerned about her malnourished state as she is not feeding well, she is always drowsy, her oral cavity is always dry with aphtous ulcers. She get confusions sort of atherosclerotic changes which were not there prior fracture. Please let us know how can we mobiles her on bed, with less pains? will the fracture heel on itself? will she be able to walk agian? why is she not feeding well like before? what can we do to avoid pressure sore on her back and the right ankle joint (calcanoues area). We are so worried as she is very much attached to us, as all mothers do to their children.
Thankyou for your time Doctor
Naushad
@Naushad Rattansi,
Sorry! The reply is delayed.
How is she now?
hey dr
im a 18 yr old girl and recently fractured my malleous bone. my cast will be coming off next week on the 19th. (after 2 and a half weeks of pop and 1 and a half week of having the plank) before this plaster, a dr had applied the wrong plaster as he hadnt placed my leg at 90 degrees to my ankle, which lasted for 2 weeks. will this effect the healing now.?
and what sort of precautions and care can i take after the cast has been removed.
i will be attending college soon and would like to know when i can return to my normal routine. also, is there a chance of this injury causing trouble later on?
pls reply. thanking you.
@shaurya misra,
Hope you are well. How is your foot and ankle?
Dear Bone and Spine,
I broke my fibia and tibia badly about ten days ago. They are now neatly realigned with rod and bolts from knee to ankle. About six days ago I noticed a pale brown blister under the lower bandage. A locum hospital doctor diagnosed that the wound was infected and prescribed penicillin. The nurse who re-dressed my leg after completely removing the previous dressing said that the wound was not infected and that it was a fracture blister. Two days later I went to my GP to check progress. He thought it was a blood blister as it had gone dark red. Yesterday I went to the fracture clinic. The Consultant had a look as it had gone flat and dark green. He said no worries it is a fracture blister. It will just go dark and drop off. It is on shin over where the fracture was. His registrar said there may be some green gunk. I am finishing off the course of antibiotics. Is there anything I should look out for just in case?
@Sazofraz,
A blister after 10 days should not be much of concern. How are you now?
sir,
i want to show my xray to u..so tell me how i can i do this..
@sukhpreet,
You can send it to contact [at] bonendspine [dot] com
I'm a 68 year old male who had a mid-shaft displaced fracture of the left humerus 2 years ago. First treated with a gravity type brace for 2 months, followed by a surgery to place a compression plate to fix a poor union. Well, now I feel a fair amount of discomfort from the hardware and am trying to decide if I should ask my surgeon to pull it all out. What are my options and my odds for such a revision compared to living with the discomfort for however many years I might survive?
@William,
If the implant is causing a trouble it should be removed. You would need to protect your arm in a splint for about six weeks following plate removal
Take care.
Hi,
I have posted a comment earlier last year when I had a femur fracture, I had a surgery and inserted an IM rod into my femur with two screws at the top by my hip and two at the bottom by knee. The fracture was a clean break, almost in the middle of the femur. the bone was split apart.
today, after one year, the bone has shown significant healing, and I am back running and working out. Of course the muscles on the left leg, with the fractured bone is still weaker, but my workout performance is gradually increasing. The last time I checked my bone with the doctors, they asked me not to follow up on it anymore, because it has reached a significant stage in healing.
Two questions I wonder about, where I can't find firm answers for:
considering that the doctors were not able to find the reason why I broke my femur – (I was playing rugby, but was not in any contact, I was simply running hard, and the bone just broke while running) – density of the bone was checked and examination under my surgery were made, nothing was observed, the doctors said that I was just unlucky in a high energy sports. Is this something I shouldn't worry about if I want to continue playing?
Another thing is, Can I play again with IM rod inserted? I was not able to see if players still play with IM rods inserted, specifically high energy sports. In spring 2013, season starts again, if I keep the progress I have now, I think I am fit again to play. But the question is, are there risks playing again? can someone play again with IM rod inserted? what are the risks?
Notes, age 28, athletic, intensly enganged in sports.
Theoretically, once the bone heals, the road is not bearing any weight. As one year has passed, the bone must have remodeled too. It would take some more time to reach its original strength.
The physical activity should not be much of concern as long as hardware itself is not causing problems So physical activity should not be a concern.
Femur Fracture,
I have posted here earlier in late 2011, I had a broken femur, and had a surgery, inserted IM rod in my femur with two screws by the hip and two by my knee. few months later I removed one screw at the bottom, the other one got stuck. Anyway, I have done good progress working out back again, and the leg seems to get back in good shape although slightly different than the other leg, but performance wise at the gym I am going just well.
The question is, I was not able to get more information on whether I can do extreme sports again with the rod in the bone. doctors don’t give me convincing answers. They say I can, but I might have to tolerate some pain, otherwise it is okay to play again with the IM rod in the bone. What are the risks to start playing rugby again? and any precautions required?
Appreciate your input on this.
Thanks and regards
Gilbert
Can I see your latest xrays please?