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Bone Fracture Healing – How Does a Bone Heal?

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Fracture healing in a broken bone is quite a complex process that begins by hematoma formation, a collection of inflammatory agents which render the bone forming cells to form bone tissue to bridge the defect created by fracture.

How Does Bone Heal- An Overview

Bone is surrounded by a thin membranous layer of tissue called periosteum. 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.

When a bone breaks, it bleeds from its torn ends due to injury to its vessels which supply the blood.

fracture healing process image
The figure represents a cut section through a bone where a fracture is healing. Normally the bone is like a cylinder. Imagine cylinder cut into halves along its longitudinal axis and you would get a similar picture. )

Injury to the vessels leads to the collection of the blood at the fracture site. The blood is collected at the fracture site. The collected blood is called fracture hematoma. [If a fracture is of open nature, then the blood comes out through the wound that communicates with fracture and hematoma is not formed. This is contemplated to be a major cause of poor bone fracture healing in open fractures.]

With a fracture, the periosteum may be completely torn or partially damaged depending upon the force of injury.

Due to loss of vascularity or blood supply adjacent portions of broken ends die. Inflammatory changes occur in the hematoma over next few hours. An inflammatory reaction by the body 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.

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 until they unite with their counterparts from other pieces of the fracture. This process forms the fracture callus or bony callus. The formation of callus is the first sign of union visible in x-ray and generally appears around 2-3 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.

fracture_callus-copy.jpg

From here on slowly and steadily bone is restructured by a process called remodeling.

Different Stages of Fracture Healing

This whole process can be divided into three phases. These phases are

  • Inflammatory phase
  • Repair phase
  • Remodeling phase

It must be understood that actual fracture healing is a continuous process and the events of different phases may overlap with respect to their occurrence.

That means events of the preceding phase may continue into next phase and events of subsequent phases may begin in an earlier phase

Inflammatory Phase

As a result of the fracture, the soft tissue envelope [periosteum and surrounding muscles] is also torn along with the break in the bone, leading to rupture of blood vessels crossing the fracture line. A hematoma is formed within the medullary canal, between the fracture ends, and beneath any elevated periosteum. Due to loss of blood supply, immediate ends of fracture fragments undergo necrosis

Necrotic material leads to an immediate and intense acute inflammatory response which leads to dilation of vessels and exudation of plasma.

This brings acute inflammatory cells – macrophages, neutrophils, and platelets which release several factors such as plasma-derived growth factor [PDGF], tumor necrosis factor –alpha, transforming growth factor-beta, IL-1,6, 10,12 etc. These factors are detected as early as 24 hours after injury.

Lack of TNF-Alpha has been found to be associated with delay of both ossification [e.g. in HIV infection]

Fibroblasts and mesenchymal cells migrate to the fracture site and granulation tissue forms around the fracture end followed by proliferation of osteoblasts and fibroblasts.

NSAIDs are known to repress runx-2/osterix which is critical for the differentiation of osteoblastic cells.

Reparative Phase

The repair cells are of mesenchymal origin and are pluripotent cells [stem cells] probably of the common origin of bone, cartilage, and collagen.

The tissue formed eventually is determined by the microenvironment. High oxygen concentration and mechanical stability favor bone formation whereas low oxygen and instability lead to the formation of cartilage.

It is notable that the blood supply of the extremity is increased as a whole after the fracture but the osteogenic response is limited largely to the zones surrounding the fracture.

The repair cells produce the tissue known as callus, which is made up of fibrous tissue, cartilage, and young, immature bone. This quickly envelopes the bone ends and leads to a gradual increase in the stability of the fracture fragments.

Primary callus forms within two weeks. If the bone ends are not touching, then bridging soft callus forms.

Enchondral ossification converts soft callus to hard or bony callus, a type of woven bone. Medullary callus also supplements the bridging soft callus

Amount of callus is dependent on the extent of immobilization.

As this phase of repair takes place, the bone ends gradually become enveloped in a fusiform mass of callus as noted in the picture above. Immobilization of the fragments occurs due to callus and is considered as on of the clinical signs of union.

Remodeling Phase

Remodeling about a fracture takes place for a prolonged period of time. In remodeling, osteoclasts resorb the woven bone trabeculae and new struts of bone are laid down that correspond to lines of force. Remodeling is thought to be modulated by electrical signals. When a bone is subjected to stress, electro-positivity occurs on the convex surface and electro-negativity on the concave, a current produced by a piezoelectric effect. Regions of electropositivity are thought to be associated with osteoclastic activity and regions of electronegativity with osteoblastic activity.

The cellular module that controls remodeling is the resorption unit, consisting of osteoclasts, which first resorb bone, followed by osteoblasts, which lay down new Haversian systems.

For bone healing to occur normally, the following requirements are to be met-

  • The viability of fragments (i.e. intact blood supply)
  • Mechanical rest – Immobilization by cast or fixation
  • Absence of infection

Approximate Fracture Healing Time in Adults Taken by Different Bones

Depending on the fracture site, normal healing may take from 3-12 weeks.

  • Phalanges: 3 weeks
  • Metacarpals: 4-6 weeks
  • Distal radius: 4-6 weeks
  • Distal Humerus: 8-10 weeks
  • Humerus: 6-8 weeks
  • Femoral neck: 12 weeks
  • Femoral shaft: 12 weeks
  • Tibia: 10 weeks

Primary and Secondary Fracture Healing

Primary fracture healing and secondary fracture healing are two different types of healing in fractures depending on the rigidity of fixation of the fracture. The one described in the initial part of the article is a type of secondary fracture healing. But when the fragments are fixed rigidly by a plate or other gadget, the type of healing that occurs is primary.

Fracture stability dictates the type of healing that will occur.

When mechanical strain is less than 2%, primary bone healing will occur. When the strain is between 2% and 10%, secondary bone healing will occur.

Thus when fracture fragments are more stable, as fixed by plate and screws primary fracture healing would occur. If the immobilization is not rigid as in plaster cast or external fixator, secondary healing would follow.

Primary Bone Healing

In this kind of fracture, healing callus is not formed at all and it occurs with rigid stabilization with or without compression of the bone ends. For example,  in a fracture fixed by plating,  primary bone fracture healing occurs. It occurs when the mechanical strain on the fracture is < 2%. It is also called intramembranous healing and occurs via Haversian remodeling.

Rigid stabilization suppresses the formation of a callus in either cancellous or cortical bone.

Primary healing per se is rare and most of the fractures heal by secondary healing. This is so because management of most of the fractures allows some degree of movement.

Primary bone fracture healing can be divided into gap healing and contact healing. Union occurs in both types.

Operated and United Radius and Ulna Fractures Healed By Primary Bone Healing
Operated and United Radius and Ulna Fractures Healed By Primary Bone Healing

Rigid stabilization suppresses the formation of a callus in either cancellous or cortical bone.

Because most fractures are managed in a way that results in some degree of motion, primary healing per se is rare.

Primary bone fracture healing can be divided into gap healing and contact healing. Union occurs in both types.

Gap Healing

If internal fixation leaves a gap between fragments, the fracture heals by gap healing.

Gap healing occurs in two stages.

Firstly, the width of the gap is filled by direct bone formation. An initial scaffold of woven bone is laid down, followed by formation of lamellar bone as support. The orientation of the new bone formed in this first stage is transverse to that of the original lamellar bone orientation.

In the second stage, which happens after several weeks, longitudinal Haversian remodeling reconstructs the necrotic fracture ends and the newly formed bone to replace the woven bone with osteons of the original orientation. In the end, the normal bone structure results.

Contact Healing

Contact healing occurs where fragments are in direct apposition with [< 0.1 mm distance] and neutralization of interfragmentary strain so that osteons can grow across the fracture site, parallel to the long axis of the bone.

The process is initiated by osteoclasts forming cutting cones, that traverse the fracture line at 50-100 µm/d. This tunneling allows the penetration of capillaries and eventually the formation of new Haversian systems. These blood vessels are then accompanied by endothelial cells and osteoprogenitor cells for osteoblasts leading to the production of osteons across the fracture line eventually leading to regeneration of the normal bone architecture.

Secondary Fracture Healing

Secondary bone fracture healing occurs when there is no rigid fixation of the fractured bone ends, which leads to the development of a fracture callus. It includes an inflammatory phase, a reparative phase, and a remodeling phase as described above at the beginning of this article.

Secondary fracture healing occurs with non-rigid fixation, as fracture braces, external fixation, bridge plating, intramedullary nailing, etc.

Bone healing can occur as a combination of the above two processes depending on the stability throughout the construct

Factors Affecting Fracture Healing

Both local and systemic variables influence the rate and degree of fracture healing.

Malunited fracture healing of distal third femur
Oblique Fracture Of Femur United In Malposition

Systemic Factors Affecting Bone Healing

Age

Fracture healing and age have an inverse relation. 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. Studies have shown as high as 84% of patients with nonunion to have metabolic issues. More than 66% of these patients had vitamin D deficiencies.

It must be mentioned that while the lack of nutrition is detrimental to bone healing, there are no bone healing foods or food that could hasten the recovery of broken bones.

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.

Calcium absorption is affected in gastric bypass patients leading to decreased Ca/Vit D levels, hyperparathyroidism (secondary) & increased calcium resorption from bone.

Diabetes mellitus affects the repair and remodeling of bone by decreasing cellularity of the callus and delayed enchondral ossification.

HIV infection has a higher prevalence of fragility fractures with associated delayed healing. Contributing factors are anti-retroviral medication, poor intraosseous circulation, TNF-Alpha deficiency, and poor nutritional intake.

Drugs

Bisphosphonates and systemic corticosteroids are associated with osteoporotic fractures in long-term use.

Use of NSAIDs is known to cause a 6.5% higher rate of intertrochanteric fracture nonunions NSAIDs and prolong healing time because of COX enzyme inhibition.

Hormones

Thyroid hormone, growth hormone, calcitonin, and others play significant roles in bone healing. Corticosteroids impede healing through many mechanisms.

Head Injury

ling nails head injury may increase osteogenic response

Local Factors Affecting Fracture Healing

Type of Bone

Cancellous (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. This is due to a decrease both in the rapidity of differentiation of the mesenchymal cells and in their total number. The soft tissue envelope around the fracture in this situation has to heal themselves as well as provide mesenchymal cells for fracture healing. In addition, the hematoma escapes into the soft tissues, leading to a diffusion of mesenchymal cell effort.

Vascular Supply and Fracture Healing

Inadequate blood supply impairs healing. Especially vulnerable areas are the femoral head, talus, and scaphoid bones.

In long bones also, studies have shown that un-reamed nails maintain the endosteal blood supply and reaming compromises of the inner 50-80% of the cortex

It is postulated that loose fitting nails would allow quick recovery of endosteal blood supply than canal filling nails.

Degree of Immobilization Affects Fracture Healing

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. The 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 the 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 defenses, which should concentrate on fracture healing would have to wall off infection, thus affecting healing.

Local Pathology

Fractures through bone involved with primary or secondary malignancies usually do not heal unless malignancy is also treated.

In nonmalignant conditions, fractures may heal but in conditions likes Paget’s disease or fibrous dysplasia, fractures heal slowly or not at all due to the failure of normal differentiation of mesenchymal cells and of ingrowth of capillaries.

The bone that has been irradiated heals at a much slower rate due to the patchy death of cells in the local region, to thrombosis of vessels, and to the fibrosis of the marrow.

Sometimes, one fracture fragment becomes avascular because fracture affects the blood supply of the fragment. Fractures associated with avascular necrosis of one fragment will heal, but the rate is slower. If both fragments are avascular, the chances for a union are very poor.

Exercise and Stress

Use of a fractured extremity promotes repair, and the recent development of weight-bearing techniques has confirmed this conviction.

Other Factors Affecting Fracture Healing

Pathoanatomy of fracture, soft tissue condition, and patient conditions are the main factors that affect the outcome of fracture treatment.

The pathoanatomy of the fracture is defined by the location, morphology, and degree of displacement of the fracture and has a marked influence on the outcome of the fracture treatment. As important as the pathoanatomy of the fracture itself is the state of the soft tissues.

A careful analysis of the pathoanatomy of the fracture and the state of the soft tissues enables us to predict the expected outcome.

Pathoanatomy of the Fracture

Anatomical Site

The natural history of the fracture is influenced by the location of the fracture, whether it is in the diaphysis, the transition zone extending into the metaphysis, or the epiphysis, with or without joint involvement.

Articular

An intraarticular fracture assumes significance and overriding importance over other injuries as the result will depend upon obtaining a stable anatomical reduction and early motion of the joint.

Metaphysis and Transition Zone

Fractures in the metaphysis or in the transition zone between the metaphysis and the diaphysis may be caused by compressive or tensile forces. If caused by compressive forces, the fractures are often crushed and axially malaligned.

Transition zone fractures caused by shear forces may be due to direct or indirect trauma.

A shearing injury through the metaphysis or the transition zone between the metaphysis and diaphysis is, therefore, a high-energy one and may be associated with considerable instability and displacement.

Cancellous metaphyseal bone heals quickly if compressed and slowly if displaced. Therefore in case of displacement and compression, open reduction and compression of some fractures in the metaphysis or the transition zone may be desirable.

Diaphysis

Unstable, displaced diaphyseal fractures often require surgery in most of the long bones as the maintenance of an acceptable reduction may be difficult and union may be delayed by non-operative means.

Morphology of Fracture

The morphology of the fracture will suggest the type of injury that caused it, whether transverse, short oblique, or spiral, displaced or undisplaced, comminuted or not.

Read more about different types of fracture

Transverse and short oblique fractures are indicative of a greater force than are spiral fractures. Marked comminution and gross displacement, suggesting complete disruption of the soft tissue, emphasize the violent nature of the injury.

Soft Tissue Injury

The state of the soft tissues is at least as important as the morphological appearance of the fracture.

Greater the trauma, the more likely the presence of major soft tissue damage.

The soft tissue damage may be overt, with an open wound, or could be in form of massive swelling, ecchymoses, and instability of the fracture.

Different soft tissue injury classification in closed fractures

Open fractures

Other Injuries to the Limb

The presence or absence of other injuries in the same limb will greatly affect the natural history of a   fracture.

The presence or absence of an arterial or nerve injury or an early compartment syndrome will greatly influence the decision-making in the management of a fracture.

Patient Factors Affecting Fracture Healing

General Considerations

Fracture healing and age are inversely related. While young children have immense power of fracture healing, it decreases with age.

In skeletally immature patients, open reduction of the is almost never indicated.

In older individuals, on the other hand, though open reduction and internal fixation are strongly indicated an important, an extremely osteoporotic bone in which it is impossible to achieve stable internal fixation or medical conditions which could affect patient’s outcome may force the treating physician to choose non-operative treatment.

The patient’s occupation and recreational habits should be known so that there can be no major disparity between the expectation of the patient and the treatment offered. For example, the expectations of an athlete are different from that of the one who leads a sedentary life.

Polytraumatized Patients

Patients with injuries to many body systems have a high risk of developing respiratory complications. If these patients are rapidly mobilized, especially in the upright position, many of these complications may be prevented or reversed.

How to Enhance Fracture Healing – Use of Stimulators

Enhancement of fracture healing is desirable where the healing is not up to mark. Though the exact mechanism and efficacy is not known, following methods of stimulation are feasible

Bone Stimulators

Bone stimulators enhance fracture healing by electrical stimulation. There are four main delivery modes of electrical stimulation

Direct current

Decrease osteoclast activity and increase osteoblast activity by reducing oxygen concentration and increasing local tissue pH.

Capacitively Coupled Electrical Fields

This supplies alternating current. These affect synthesis of cAMP, collagen, and calcification of cartilage.

Pulsed Electromagnetic Fields

cause calcification of fibrocartilage

Combined Magnetic Fields

They lead to elevated concentrations of TGF-Beta and BMP.

Low-Intensity Pulsed Ultrasound (LIPUS)

The exact mechanism for enhancement of fracture healing is not clear but the alteration of protein expression, increase in vascularity and development of mechanical strain gradient are thought to be the reasons to accelerate fracture healing. LIPUS is also known to increase the mechanical strength of callus (including torque and stiffness)

Healing rates for delayed unions/nonunions have been reported to be close to 80%

Impaired Fracture Healing

Normal fracture healing can be disrupted in numerous ways:

Delayed Union

Fracture healing takes about twice as long as expected for a specific location

Non-union

Fracture healing does not occur within 6-9 months. Sites with known predilection are scaphoid bone, femoral neck, tibial shaft

Malunion

It means healing of the fractures in the wrong position. It may or may not be compensated to a certain degree by remodeling of the bone.

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Reader Interactions

Comments

  1. This is a very good explanation..its clear and easy to understand. I really happy to get this source and use it as my reference for my presentation on my learning issue tomorrow…

    Thank you and just to ask if you can add some more about other stages of bone healing and other factors influencing bone healing such as infection, diabetic or other stuff

    Thank you

  2. Taukoriri,

    Thanks for your appreciation and encouraging words. I am glad information helped you.

    I have made a note of what you have asked and would surely make a post on that

  3. Yes, thank you Dr. Arun Pal Singh for taking the time to explain this process. I recently broke my 5ht metatarsal and was looking for a better understanding of the healing process so I could visualize and help my body heal. Your description was very helpful.

  5. i meet with an accident my foot toes bones are broken, doctor told me to have rest for 1 and half month, i have to go my office, please suggest for fast healing.

  6. Arvind,

    If your doctor has suggested you rest, there must be reason for that.

    Bone healing is a gradual process and till now there is practically nothing that would augment healing.

    You can discuss with your doctor. If you just have toe fractures, it might be possible to visit office with cast/brace you have after few days of rest.

    But you must discuss it with your doctor.

    I hope that helps.

  7. I broke (picture this bone-space-bone) my fifth metatarsal and kept walking on it for about 10 days (doctor's visit was impossible). When I saw my foot doctor, he put me in a "boot." Unfortunately, after about 5 days in the boot (during which time I walked with crutches), there was a death in the family and that necessitated four days with a great deal of activity on my foot. When I returned (because I definitely felt something else was wrong), one of the broken-bone segments had slid along side the other. Now I am in a cast. My doctor assures me that although I have osteoporosis (I am on Fosamax), the prognosis is good. How long will I be on the cast: weeks, months??Please notify me via e-mail of followup. Thanks

  8. Usual waiting time is 4-6 weeks. Your osteoporosis should not adversely affect your healing.

    I hope that helps.

  9. Yes, your response does help! Just that little reassurance is so-o-o good for my mental health! I am normally a very positive person, but I must admit this had me a little down. God bless and happy holidays (whichever you celebrate) ! :) :) ! No need to respond this time.

  10. I was in a car accident thanksgiving night. Among other things ( including a cracked vertibrea "C7" which has healed ) I completely fractured and tore my forearm; radius and ulna. They set the bones w/ metal rods and screws. At my 6 week check up the orthopedist said he wished it look a little better. They are now seeing me in another month.

    How long should something like this take. I have no other diseases and I am a 25 yr old male. If this helps I do not have any pain at all.

  11. John,

    Was it an open fracture? Your records would help you to find this. What I am asking is presence or abssence of wound over the fractured bones.

    Why did your orthopedist said so? Dis you enquire further what was meant by that.

    Fracture healing takes different times in different individuals. We usually give 6-12 weeks range but by no means that is absolute.

    Let me know what else I can do for you?

  12. I had a spiral fracture of the fibula (lateral malelous). im moving on my 5th week since the day of my injury. i just want to know how long would it take me to heal my fractured fibula. my doctor adviced me to see him on april. is there a possibility that my ankle would heal before april. thanks.

  13. 6-12 weeks is the usual time a fracture takes. Because the fracture is spiral, it may happen earlier too if it is well in position

  14. This is a very importent and useful page. This will be helpful for students and other peoples also. I will use this as a reference.

  16. Tibial Plateau Fracture Lateral side , non displaced about 3 cm long , no pain at all , use crutches when i can and when not too tired … how long do these typically take to heal ?

  18. Hello Doc, I met with an accident in which I have broken my patella and right radius . I was operated for the same , but there is a crackling sound in the right radius , I dont know why this is happening and as to the patella it getting good except wid some pain at times in the adjoining muscles. can u suggest me any particular food that will help heal faster.

  19. Hi Very good explanation,

    I had a complete bone fracture of Left Humerus in 2002. The bone was jointed using a steel plate with screws and the plate is still in my body.

    Can you please tell me if it is advisable to take out the steel plate now?

    And can I do push ups ? Doing so will it hurt my bone in terms of strength and rupture with steel plate?

    Thanks in advance.

    Krishna

  20. Doctor Singh, by the way I had a spiral fracture of the fibula (lateral malleolus). and it has been 7 weeks and i had my cast removed yesterday. I just want to ask if the bone have callous formation; is there a tendency for it to break again if I will push myself to hard on my rehabilitation therapy? How long should the rehab be? Thank you.

  21. Yashwant,

    if you have have been operated with satisfactory soutcome the sound cannot be from bone. It could be sound from gliding tendon.

    As such there is no special or particular food for healing of fracture. But you must take a diet rich in calcium and proteins

  22. Krishna,

    Until they cause problems, it is not advisable to remove the hardware. TO answer your question, if the fracture has united, the plate can be taken out.

    But remember! You would need to protected for six weeks in a cast after plate removal.

    If it is not causing any problem, leave it as such. If your bone has united, you can do all the normal activities because the stress would be taken by bone.

    Consult an orthopedician in vicinity. Discuss your querie with him.

    If there is any confusion, you can ask me any time.

  23. John,

    First we need to see that lateral malleolus has united and is in acceptable postion. An xray would help in this regard.

    Lateral malleolus takes part information of joint. So your activities would affect not only the mallleolus but also the joint. Start slowly and progress gradually. Our body does not like onslaughts.

    Your would be able to decide how much is enough. if in doubt, consult your physio trainer.

  24. My 13 year old grandson is wearing a back brace for a football related compression fracture in his lower lumbar. Considering his young age: 1) approximately how long would you expect it to take for healing to be complete enough for a return to normal activities? (He will not be playing football again.) 2) In your experience, If a patient increases his protein and mineral intake, can the new bone repair become as strong or stronger than the original bone? 3) He is overweight. After he heals, what would be the best activity to lose weight and strengthen his spine? Thanks.

  25. It usually takes 3-6 months. The bone will reach its original strength but compression might remain visible. High protein diet does help in repair.

    If he want to loose weight, he should do exercises under supervision.

    I hope that helps.

  26. I fractured my left ankle last week and damaged the ligaments. The doctor says I'll be in a cast for the next three weeks then will wear a boot for a number of weeks after that. Apparently, I do not have a serious fracture, I won't require surgery, and it will heal wtih little problems.

    My question is, when I get the boot, will i be able to walk on it? How long will it take to resume normal activities?

    Thank you. (Very good article, helped me understand what is going on.)

  27. This is a very useful page, thanks.

    I fractured my fibula when I slipped while jogging. How long do you think it will take before I can run again? Will running damage it? Would wearing a lace-up ankle brace help? Thanks

  28. Yvonne,

    It would depend upon the level at which fibula is fractured. if it is near ankle, things take more time to get back to normal than if it was in middle or so.

    8-12 weeks is the usual time to normalise the things. Some people might take more depending on soft tissue injury.

    i hope that helps.

  29. Vanessa,

    Most probably yes but only your doctor can confirm it. Tissues take about 2-3 months to heal completely. if injury is severe, it could be longer.

  30. Srinivas,

    K wire and a plate? were there two fractures?

    Was there any particular reason that a cast was kept for 11 weeks.?

    Please let me know.

  31. Srinivas,

    You should have mentioned complete nature of injury in last comment. anyhow, if you have had trimalleolar fracture, you seem to be treated on right line.

    Operative treatment is the best option for trimalleolar fracture and they do take this much time.

    You can consult with your doctor but in my view you should be upright without assistance in another month. Sometimes soft tissues take more time to normalise but that would be better explained by your treating physician.

  32. Dr Singh,

    I was in a car accident exactly a month ago and had a compression fracture in my L1. They took an xray and CT soon after and determined I had to wear a jewitt brace for 4 weeks and return for a follow up, which I assume is to see whether or not I can start functioning without the brace.

    Today was my dr's visit and they took another xray, but no CT and determined that my spine has remained aligned, but for precaution I continue wearing the brace until June 15th, the next followup.

    I want to know is, why did they extend my recovery time. I felt a CT should've been done today to look at how much has healed. Overall, I've slowly started functioning on my own without the brace and now this news frightens me.

    How long does it usually take for this type of compression to heal? and should a CT have been done today along with an xray? I'm a 22 year old female that is completely healthy. I would really like to know.

    Thank you!!!

  33. Tiffany ,

    You did not mention it but I assume it from your notes that compression was of mild to moderate degrees and there was no neurological deficit. In spinal injuries, protection is given for longer periods. I personally recommend them for up to 6 months wherever required.

    It appears that you assumed the removal of brace at your second visit. Because it did not happen so you are getting concerned.

    At first time, the CT might have been needed to know the exact fracture pattern. But CT is not necessary at every follow up nor it is done that frequently. Xray is good modality to note the healing and it was done.

    Compression fractures as such heal quite well. Usual time taken is 8-12 weeks. Additional protection may be given for longer period if required because of nature of injury.

    A brace is usually removed in gradual fashion.

    There is nothing to be frightened of. Unfortunately braces do not seem to be very friendly but they offer good support.

    As you are young and healthy otherwise, your tissues should show a good response.

    Take care.

  34. Dr. Singh.

    Does the gap in bone from a small blowout fracture of the orbit fill in with new bone? No surgery was needed.

  35. Dr Arunpal Singh,

    i had a car accident in which my left hand radius and ulna both were broken.It was not open woun , but surgery was done to fix the bone with plates and screw. The union was delayed. After 3 months my callus formation was weak.Doctor prescribed sodium alendronate and calcium tablets now the healing is going fine.Should i remove the plates after the healing is complete or can i leave it like that.Doctors are giving different opinions.My age is 32, they are concerned of the age factor.

    Regards

    rakesh

  36. Eight weeks ago I cut through my left arm with a circular saw. It cut 3/4 the way through the ulna about 3 inches below my elbow. I have a plate and screws in, I did’t loose any important tendons. I had an apendectomy 3 weeks ago, followed by a stomach virus. The doctor was dissapointed with my progress. The void in the bone still looked dark in the xray. He’s given me 4 more weeks to heal. If I don’t improve he’s injecting graphing material in. Do you think the extra month will really help. By the way I’m 31, male and, in good health, besides all of what just happended. Thank You for your time.

  37. Jon,

    You would need to consult an eye surgeon/ facial surgeon for that. It is beyond my field of expertise.

  38. Bharat,

    1 Swelling and stiffness are normal after injury/surgery. As you work out on your ankle with physiotherapy, it would become better with time.

    2 That depends on your injury, fixation and physiotherapy but if everything is fine, you should be walking in another 4-6 weeks.

    3. Only time would tell that. i hope you are free of any restriction.

    Take care.

  39. Rakesh,

    Plates are not removed before 2 years after fracture has united radiologically. That too if they are causing some symptoms.

    Early removal would increase the risk of refracture.
    I would suggest you to do nothing if you do not have any problem.

  40. Messier,

    I would need to have a look at xrays before I could comment. Could you mail me xrays before and after surgery and then leave a comment here so that the mail is not lost.

  41. Hi Doctor,

    Thanks for the information. 2 weeks back my son (20 months old) has broken his right hand [just below his shoulder] it got into 2 pieces. Doctors say after 4 weeks we can remove the pluster. please advice me is it a right thing to remove the pluster at end of the 4th week?

    Regards,

    Anil

  42. two months ago i faced a car accident and i had spine column injury and i was operated now can walk but
    i can not run and also i can not bend myself what should i do in order to run or walk fast
    navid

  43. Dear Dr Singh,

    i was involved in a car accident about 2 months ago in a foreign city. the x rays and a later CT scan revealed i had a burst L4 fracture of the spine. The doctor -a neurosurgeon- had concerns about a slight compression/narrowing of the canal at the L4 and L3 junction and asked if i had any numbness or tingling feeling in my legs. i had none. He put me on a 4 week complete bedrest treatment without any bracing and allowed for short walking trips to the bathroom.

    After 4 weeks i was asked to get a follow up xray and an MRI to show the healing progress. he said that the progress was fine but i would need 4- 6 more weeks of bedrest. i had started getting occasional pains in my ankles and shin, he expressed concern for this but said he would address it after the bone had healed. he proposed a small surgery at a later date to relieve the pressure of the spinal cord at the point where it had narrowed.

    i also consulted an orthopaedic doctor who expressed his horror at my being allowed to walk a bit after 4 weeks! according to him, the fracture had actually disjointed more! he told me to immediately get back to bedresting for another 6 weeks! he asked me to use crutches when going to the bathroom and to avoid sitting at all. again, there was no mention of any bracing. he also asked me to keep a rolled towel below ths small of my back to maintain lordosis.

    i would like to know how long a lumbar fracture takes to heal and what are the precautions to take in order to aid the healing process considering i'm not wearing any braces. its already 9 weeks since the accident and i need to know when is it safe to travel so i can get back home and continue with the follow up treatments from there.

    murtaza, nairobi (but currently in dar es salaam)

  44. I was wondering when I will be starting to walk after a trimalleolar fracture. I suffered the fracture on 4/4/09, had ORIF surgery on 4/9/09 4" plate and 8 screws. On 4/22/09, had staples out and was put into the darth boot and told NWB for 4 weeks. I am going to OS in 2 days for a follow-up, what should I expect? Some say I will be PWB, if xrays look good, but still have the boot. How much longer with this injury? I haven't had any complications, I did not suffer a dislocation.

  45. @Navid,

    Two months is too soon for all this if you have had a spinal injury. Talk to your physician before you do all this. He/she would be better to guide you on this.

  46. @Ebags1,

    These questions demand specific answers but I cannot provide you such answers. the best person to ask these is your doctor.

    Different people behave differently and very case is unique. So people tell you different things because each one assumes that this is the only course.

    Your course would depend on how you have made progress.

    In usual course, most of people start walking within 2-4 months.

    I hope that helps.

  47. @murtaza,

    What i am telling you is the generalised treatment. your doctors are the best person to decide on your treatment as they have more information on your problem.

    On conservative treatment, the person needs to take rest for long usually 8-12 weeks or more if required. After that , a person is allowed to move around with a brace. But braces do not prevent any deformity as such. So some people do not prescribe them.

    If you can manage to go in lying position I think it is okay to travel. But you need to consult with your doctor for final decision on this.

    Take care.

  48. @Anil,

    children have a tremendous capacity to heal and it occurs at quite a pace. I think it is okay to remove the plaster after 4 weeks if everything goes well.

  49. Thanks Doc!!

    My OS says I will be back to normal by July 4th. I am progressing pretty well, actually a little quicker than average. I can already dorsal flex my foot, wiggle all toes freely and put my foot down on the ground in a 90 degree angle. Doc also sd that my swelling or lack there of was amazing.

  50. @Ebags1,

    It is good to hear that you are making good progress. May you get well soon

  51. I saw my OS and I am now WBAT (50-100%). What type of gentle exercises should I do to decrease the stiffness in my ankle? I don't have any pain when bearing weight, however the ankle is very stiff. I let it soak in the bath today and that seemed to loosen it up a little.

    Thanks for any info you can provide.

  52. @ebags1,

    Warm comprsses and active ankle mobilization exercises would help you to gain back ankle motion.

  53. What kind of conversation would you have with a patient if they had a non severe bone fracture in their foot.

    I know that's a silly question, but I mean, how would you explain it to them in simple terms,

    and what would you do about it, how would you help it heal. And how long would it take..

    Thanksssss.

  54. I had minimally invasive spinal surgery march 24 09. The neurosurgeon advised the procedure was successful. I am still experiencing low back pain requiring medication. The procedure included laser shrinking of L 2,3,4,5 and trimming of osteophytes on the vertebrae. After reading the comments of others it seems to take months for the bones to heal. When should I expect to be pain free.

    Thanks.

  55. Steve,

    What was surgery done for and please also let me know a brief about your disease profile.

    I need that information before I can deduce anything.

  56. The surgery was to address herniated discs and also to relieve osteophyte pressure on nerves. I had lower back pain and numbness in both feet.

  57. @Kate,

    The answer varies according to type of fracture and patient profile and presence of any factors that might affect the outcome.

    What I mean is that untill you ask me something specific, I would not he able to answer. If you want to know about foot injury, you need to provide me details of it including the treatment if any.

    I would try to keep it as simple as possible :-

    Take care.

  58. @steve mensen,

    Okay! In that case you must understand that backpain is very complex problem in terms of causes and behavior. While pressure on the nerve roots might be relieved by surgery, cause of backpain could be obscure and not localizable,

    As far as I gather you were operated for numbness to relieve the compression of the nerve roots.

    But backpain respondes a bit differently unless we are able to localize the origin.

    As you have so many osteophytes, it suggests degenerative spine an age related phenomenon. Thus there could be various causes of pain.

    You must discuss it with your doctor and ask him if you should expect a complete relief of the back pain.

    There should be some but your surgeon would be able to tell you better.

    Let me know and we can discuss it further.

    Take care

  59. I had a trimalleolar fracture and on fibula near ankle. I had ORIF surgery on 11th Feb, 2009, a plate and 6 screws and K wire. On 26th Feb staples were out and POP cast was done. After subsequent x-rays cast was removed on 30th April, 2009 i.e, after 2 months and 17 days.

    For 2 weeks i did ankle up-down exercise and then I started applying 25% wt on effected leg. This I continued for 2 weeks though I was to do for 3 weeks. Then I start applying 50% wt. I use walker. I started walking little more like 700 metres distributed throughout the day( taking regular breaks). Now I feel little pain on the front of ankle(after walk) but disappears after some rest. When day finishes(before sleep at night ) I find swelling on the lower leg(effected part) but next morning the swelling almost disappears.

    Is all this normal ? SHUD I CUT DOWN OR PUSH THROUGH A LITTLE MORE IN MY REHAB.

    I’m just wondering when I can walk without help. I’m 35 years old, weight 70 kgs, general health is ok.

    Please Advice……..thanks in advance

  60. hi Dr. Singh,

    i fractured the shaft of my fifth metatarsal 14 days ago today. the doctor had a cast put on me and said i would need it for five weeks. i got another x-ray yesterday,13 days since fracture, by a different doctor and does'nt think ther has been any healing. over the years, i've been unfortunate enough to fracture my cheekbone, wrist, scaphoid, ankle and ribs. all of these injuries healed well and quicker than the time i was initially told they would. the cast is driving me insane as i'm due to play overseas basketball in august, and this is the last opportunity i will ever get at 27. do you think the bone should be showing signs of knitting back together by now, and if it does start to heal, when do you think would be a good time to take off the cast. please tell me what you think i should do.

    andrew

  61. @Srinivas Rao,

    You seem to be progressing fine. Do not worry about minor swellings. They would go with time.

  62. @andrew,
    I can understand your apprehension but injury needs to heal before you can do anything.

    Before I comment on your injury, I need to know th nature of injury. Was it displaced? did you have a wound?

  63. I had a humeral fracture in Jan. 2008. After rodding in Feb. 2008 and grafting–morphogenic–in Jan. 2009, I still have no healing of the fracture. Now my orthopedic surgeon is talking compression clamp(?). What are my other options? It’s a clean break mid-shaft.
    Thanks.

  64. @Jay,

    I do not think I understamd the word compression clamp
    Does that mean compression plating.

    Because that is a another option in these fractures.

  65. Hi,

    8 weeks ago I fell and broke my 5th metatarsal on my right foot. I was put on crutches and a boot, no cast. I just got back from the dr and he palpated the area for pain, to which I had none, but the xray clearly showed the fracture…he said it was most likely filling with soft tissue and I could walk as long as there was no pain, and if that occured to go back to the crutches and boot………….I have been able to walk about 1 hour in total in the last 4 days, but being very conservative I dont want to re-injure the healing area. I am 52 years old, very active, swim, run (well until I broke my foot), a non-smoker. He has me scheduled to come back to see him August 7 (7 weeks away – which will make 13 weeks since breaking my foot), in your opinion, is there an average time when I can resume walking? Anxious to walk again……………then maybe resume running sometime down the road.

    Many thanks,

    Mike

  66. I meant to also mention, that it was not a compound fracture…..but a closed break. He also called it a Jones Fracture.

    Thanks again,

    Mike

  67. @MIke,

    Sometimes the xray may show line for long time.

    If you do not have pain, you can work towards walking gradually.

    Jones fracture usually do not cause much trouble in healing. It is always difficult to put a time frame but most of people walk within 8-12 weeks with this injury.

  69. hi. i had a right humeral shaft oblique closed fracture, distal 3rd due to fall 3 weeks ago and currently on cast. surgery wasn't performed. i chose the conservative management. how long will it heal? how many weeks ill be on cast? thank you.

  70. @mike trillo,

    Usual time for conservative treatment is 8-12 weeks followed by physiotherapy.

    It is advisable to get frequent xrays for initial three weeks to know if position is maintained or not.

    it is all the more important in distal third oblique fractures.

  71. Dr. Singh,

    I recently fractured a bunch of metatarsals in my right foot. Last week I had xrays taken 3 weeks post-op, and so far it showed no sign of union. I think that can be normal. I'll get another xray in 2 more weeks to see if any cartilage is forming around the breaks.

    I show a picture of the metatarsals "PINNED" at footsahurtin.wordpress.com/2009/06/06/fractured-metatarsals/ , or you could google footsahurtin and then click HOME.

    Since i broke 4 or my 5 metatarsals, how long would you guess that it could be before I am actually walking comfortably again with FULL weight bearing? 8 weeks?? 12 weeks?? Up to a year??

  72. @footsahurtin,

    I had a look at your images. your fractures have been fixed well and aligned satisfactorily. in a normal course the foot bones take from 4-8 weeks to unite.

    Every individual is different but people start walking independently after 12-16 weeks. Some vague pains may persist for sometime but generally foot shows satisfactory results.

  73. Hi Dr. Singh,

    I had fall from a ladder on 22nd June 2009 and fractured both my wrists, initially I had a POP plaster . After few days doctor said that alignment in left hand was not satisfactory, on 2nd July , doctor opened the cast and again aligned the bones in both my hands. Now I have a synthetic cast. Pain has subsided but there is pain in fingers and near elbow. How much time will it take to heal.

  74. @Sam,

    Fractures of wrist usually unite between 4-6 weeks. Return to previous function level might take longer.

  75. Dear Dr. Singh

    It has been 3.5 months since my car accident where I compressed my L1. The dr showed me my xray and it looks like a trapezoid on that one bone, but thankfully it's not compressed on the side of my spinal cord. I have stopped wearing the brace and overall have been feeling well except for mornings except for some stiffness occasionally. I was wondering if it's okay now to slowly begin personal training to build back strength from the time that I've been inactive. I would really like to get back into shape. Please let me know if it's okay. I'm 22 and completely healthy otherwise.

    Thanks,

    Tiffany

  76. Hi..I broke my forehand in the middle of frontarm., not joins..after 3week i have still pain, does it normal..Is it necessary to have surgery..And when the healing occurs..

    thanks..

  77. @Tiffany,

    3.5 months is quite a time to start your back strengthening exercises but you need to ask your physician before you go about it.

  78. No! It is not necessary to always treat these fractures surgically in fractures which were not displaced to begin with and fractures which have been reduced and held in the same position.

    Healing is an ongoing process and takes years to complete. But one can become splint free in 812 weeks.

    I hope that helps

  79. Dr. Singh,

    It has been around a month since I broke my wrists(both), Pain has also subsided, my Doctor says he will remove the cast on 10th of august, is it ok that I work on laptop and can I start picking up objects.

    Regards,

    Sam

  81. Hi! My 6 year old son fractured his radius and ulna in his right arm after falling off his bike about a month ago. The bone specialist saw him and said that the break was angled at 30 degrees, and recommended closed reduction to straighten the bones out. The first closed reduction (while my son was under anesthesia) which was not entirely successful. The doctor reported a week later that while the bone was less angled he was still concerned about the amount of angulation and suggested that we try again. We went to the outpatient surgery again, where the doctor cut the bottom of the cast and "wedged" the cast as he put it, and try to straighten out the bone again. He did this and said that they were able to move the bone slightly, and he thought this would be successful. I took my son back to the doctor two days ago and the doctor said that the bone was still slightly angled, which I understand, things like this aren't going to turn out perfectly. He then told me to wait 10 days, and return on August 5th to have the cast removed and to be x-rayed again. He told me that we would then decide if he was to be placed in a short arm cast. (He has been in a long arm cast for the past 3 weeks now.)

    I have so many concerns, and I feel kind of silly asking the doctor these questions! Do you think that he is going to completely take the cast off after only a month? Or when he said discuss the short arm cast option he ment that he was deciding whether or not to put a long arm cast back on?

    I saw the new x-rays this past Monday and his arm still looks quite broke, and I'm concerned that it's not healing correctly. I was also informed that when the cast is removed that my sons arm may look slightly bent until the bones start to grow back out again. Now I'm concerned that his arm will be weak and easily breakable once the cast is removed.

    I'm trying to include the initial x-ray of my son's arm in my gravatar so you can hopefully get a visual and possibly make more sense between the x-ray and the doctors thoughts. This would be GREATLY appreciated!!

    Thank you!!!

  82. @Holly,

    I am yet to see a healthy child of that age who does not get union of fracture. Union is a kind of rulle in children and if your child has been healthy, you should not worry about healing.

    I usually prescribe short arm functional cast in children after taking out long arm cast. It is okay to remove the cast at 4 weeks.

    Yes! the arm is weaker for some duration and that is why short arm cast is prescribed for another 2-4 weeks.

    Even after that bone takes time to strengthen. It does reach the original strength but till that time one should be extra cautious not to cause trauma again.

    And if it is not angled much, it would get better as he grows.

    One last thing! You can ask your doctor whatever you want. if it addresses your concerns, it is not silly.

    All the best.

  83. Dr. Arun Pal Singh,

    I fractured the proximal end of my 5th metatarsal 3 weeks ago and have been placed in a boot. Upon my 3 week orthopedic check-up 3 days ago My physician saw no indication of healing on the x-ray. There is an approximate 3mm displacement laterally with 1mm medially. He said I could have surgery or wait 3 more weeks to see if healing initiates. I am 48 years old, do not smoke healthy weight and eating habits. However was very disappointed to not have seen any sign of healing. Since yesterday I have had a sporadic tingling pain at the fracture site that kept me up a good part of the night. I am not a fan of medication. 1st. Is it ok to take so long for the initial signs of healing. 2nd. What would cause that tingling pain, again it is not consistant.

  84. @Janice,

    Fractures of proximal end of 5th metatarsal mostly unite without any problem. 3mmX1mm is not a significant displacement. So I think union should not be a problem.

    Xray might show a translucent line for a longer time. If you have reduced pain and decrease in tenderness, your body is attempting a healing process.

    Wait for 3 weeks and then get yourself assessed again.

    Check if your splint/boot is tight or becomes tight intermittently due to swelling of the foot. That may be cause of pain. If it is so, please keep your limb elevated for majority of time.

    I hope that helps.

  85. 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.

  86. @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.

  87. Dr. Arun,

    Good day, i had a fracture almost 6 weeks already, it's on the left 5th metatarsal. They put me on cast for almost 5 weeeks. then now they removed on they just put tubigrip. But my problem is still there is swelling and pain on the site. Is it normal that swelling is still there and i'm still afraid to put my weight on that site. How many weeks it will take to the bone to be heal.

  88. @berna,

    Pain and swelling may persist for some time but by this time the bone must have healed to allow sufficient weight bearing.

    You might take a stick for initial period if you ae uncomfortable.

  89. Dear Dr. Singh,

    I am a healthy 65 year old, who fell after falling on very uneven pavement, turned an ankle, and broke my fibula this past Tuesday. The bone was not separated in the x-ray, so the orthopedist gave me a Biomet Brace with velcro fastenings and said to wear it for six weeks. He said that I could walk as long as I wasn't in severe pain and to just play it by ear. I can remove it to sleep and to shower. I go back for another x-ray on August 25, 13 days after the initial diagnosis. My question is, can I really be walking around, or should I be lying down and elevating the leg? What will help with healing faster? Should I continue with ice or use heat? I want to do everything "right," but it's unclear what "right" is. Any advice would be appreciated.

  90. @Barbara,
    Your fibula could have broken in two ways – either by hitting a hard surface or due to twist itself.

    If it is broken due to direct injury to it, you can walk as guided by your pain.

    But if it is broken due to the ankle twist, it must have caused injury to the tissues on your medial (inner) side of ankle. This would be evident by swelling, pain and tenderness on inner side of the ankle.

    In this case, you need to provide rest to the ankle joint for 2-3 weeks+ limb elevation and active toe movement.

    In latter case, the fibula would be broken near the ankle.

    From your orthopedist's advice it seems that you just have a fracture of fibula without any injury to ankle.

    But if you have doubts or pain in the ankle, you can speak to him again.

    Ice is applied for initial few days only. Heat has no role in acute trauma.

  91. I am a 27 year old university teacher in physics.

    I met an accident on july 8th 2009. I slipped while driving a scooter.

    It resulted in a fracture in my leg. the prescription of the orthopeadic reads like this : ” # LAT.MALLEOLLUS WITH 1/ST, 2/ND & 3/RD M. T.(LT) FOOT ”

    Moreover the ancle had twistedand was evidenced by swelling around it and on the back of it also. thogh the fracture was not evidenced in X-ray, the sever pain made us to realize it.

    The orthopeadic applied a slab for around 24 days. when the plaster were removed, i went under physiotherapy for around 10 days. And I am still practicing the exercises prescribed by him.

    my concern is that even after around 40 days, there is still some swelling around the fractured region. And it increases in measures when I am standing for just 10 minutes or I walk even half a Kilometer. As I am a Teacher in the University. this much walking is a must for me to move from one class to lab to department etc.

    I want to know that

    1.why does it swell when the fractured part comes under stress?

    2. will it have any negative effect on healing of the fracture?

    3. what measures should I take to let it heal fast along with my job, as the university is denying me further leaves( I have already taken more than 35 leaves for this.)

    4.i am not able to walk properly as well (no other defects are present). Physio and ortho have said that it will come in its rhythm in 3 to 4 months.

    Any advice or comments.(please do not mind the language, as I am not very good at English)

    Thanks in advance

  92. @Manish Jayswal,

    It is common to have a swelling even after fracture is healed. The swelling is because of impaired drainage of fluid rather than stress on the fracture. This impairment occurs due to injnury per se.

    Typical swelling increases when you stand for a prolonged duration or walk for somet time. The reason is again the same. Because these positions put foot at further disadvantage.

    But except for unsightly look and shoe wear problem, the swelling does not cause much of discomfort. It would go slowly with time.

    Following measures help in tackling with this problem.

    Avoid standing for long time.

    Wear a good loose shoe/sandal/slipper with allowance for swelling.

    Raise your feet intermittently on a stool when you sit.

    Avoid keeping your foot in dependent position when you sit.

    Continue your mobilization exercises as advised.

    Things would get better with time. All the best.

  93. I am a healthy 53 year old man who eats healthy and doesn't smoke. I fractured the tip (tuft?) of my left big toe when a guy at work dropped a 70 lbs object on my toe on April 10th. The impact shattered the bone and there are several breaks radiating out from the impact zone. I have been to 3 doctors and the first doctor would not give me anything and said they can't do anything for a toe tip break. They sent me on my way and I subsquetly hit and injured my toe six times before they would give me a boot. I had to modify the design of the boot sice wearing it caused more injury to my toe.

    The last xrays clearly show a shattered toe. The orthopedic sugeon thought I had soft tissue trama when a tender lump formed under the toe appearently pushing up the bones and keeping them apart. An MRI was done and he took a quick look at them and thought it was a healing fracture and not a non union as originally thought. I took a closer look at the MRI and clearly see jagged dark lines indicating a break. Some look as wide as 1 mm. What should the breaks look like if they are healing? Should the lines be white in an MRI or Xray if they are healing?

    I have painful swelling every night and yeasterday he said I should try to walk and put weight on the foot. I walked around all day today on it and now have more swelling and pain. The doctor told me to wrap my toe tightly to the to get the lump to go down. This doctor thinks that there is nerve damage and that is causing the swelling not the break. He wants me to have a "sympathic nerve block" done with an injection to the spine to temporarily shut down the nerve and reset it.. I don't like the sound of that! It has been 138 days since the break occured. Is this normal ? Will it ever heal? This last doctor seems disinterested in helping me since he sees it as such little break.

  94. Hi Judy here i fractured my 4th 5th metatarsal 8 weeks ago it does not hurt anymore but as soon as i start walking my ankle and the top of my foot swells it is fine if i keep it elevated is this normal after a fracture and how long will this take to go back to normal

  95. My wife fell down on a slippery floor and suffered fracture on her right leg on 16th July 2009. Next morning she felt swelling and pain in the leg and was not able to move the leg she attended a local orthopedic centre where the doctor pur a plaster on her leg and advised for six week''s rest. The plaster was removed on 20/08/2009 and a xray was done which showed the fracture has healed. She was advised 4 week's rest. But she is not able to walk and a sort of filthy smell comes from her feet. What is your advise. Should we take a second opinion by visiting any other orthopedic centre? Please advese.

  96. Dr Arun- On July 21, 2009 I sustained fractures in my 4th and 5th metatarsals. I was put in a splint by the ER and then was sent to a Ortho were they put me in a cast. 2 weeks later I go for a recheck and of course there is no sign of healing (that seems to be a common thing) so I am put into another cast for 4 more weeks with crutches. I am still able to work with the use of my crutches but I know that my boss isnt going to keep me around for much longer with a broke foot. I really need to get this foot healed or I am going to lose my job and not be able to support my family. What I really want to know is is there a higher chance that I will have to have surgery OR is there more of a chance that the fractures will heal within the normal time limit. I read an another website that it can take up to 20 weeks for them to heal and it has me just a tad bit worried. I am 21 years old and very anxious to get up and start walking, driving, dancing……all the fun stuff that I havent been able to do in over a month! From what I know there was no displacement and the bones were aligned at my last visit. I have also been taking calcium supplements (not saying that I do not get enough in my diet or that I broke my foot due to lack of it) but I have heard about all of the benefits that calcium can have on the bones and thought that maybe the calciun could maybe speed up the healing process or make the bones stronger. Are the calcium supplements worth taking? Thanks for your time!

  97. @Randy Mills,
    Sorry for the delay. Could you please mail me an xray and a photograph of your toe.

    I need to take a look.

  98. @Judy,
    Yes. It can occur in some people and the time taken to to go back to normal may be frm few monthd to a year.

    Try to avoid prolonged hanging of the foot.

  100. @WillJam,

    Metatarsal fractures heal most of the times until they are open or associated wita pathology or are displaced widely. The sign of healing on xrays may not appear untill 3 weeks. So do not worry about that.

    By your description, your fractures must have healed by now enough to let you walk with a stick.

    Calcium supplements are useless if you are taking a good diet.

  101. Thank you for your response. I have a PDF file with my x-rays, MRI and photographs of my toe. How do I send them to you? Do you have a regular email address?

  102. Dr Arun,

    I'm a 49yo female with osteopenia post-oophorectomy. On Memorial Day an object fell on my left foot from the top of a fridge. I had really sharp pain the rest of the day, bruising and swelling, with point pain on the top and bottom of the area of the 2nd and 3rd metatarsals… but hard to localize with all the bruising.

    Urgent Care said I most likely have a fracture, but the podiatrist wasn't sure, so he prescribed ice, ibuprofen, and a stiff surgical shoe, and the pain receded over weeks. However, even this last month it still throbs when I walk on it in barefoot, and, more disturbingly, when barefoot I have a sensation of a pebble on the underside of my foot, under the 2nd metatarsal. Also some tingling and partial numbness under the metatarsal, some pain shooting into the first and 2nd toes, and still point pain with some movements — but I can move the toes. I can stand on my tiptoes without pain, but I don't feel the floor as clearly with that part of my left foot.

    (I feel embarrassed that I hadn't caught this earlier. What I've just figured out is that I don't feel the pain in SAS sandals, which have a well-padded sole. (due to painful peripheral neuropathy I normally wear well-padded SAS sandals, even indoors, and put them on as soon as I get up) .. So I only feel the pain when I am in less-padded shoes, or barefoot on a hard surface, e.g. when showering ).

    Now I am concerned that I may have a partially-healed fracture, but with the bones misaligned, irritating a nerve. What should I do at this point? Assuming it is a fracture, what can be done this late after the injury? And, if the podiatrist didn't see a fracture on the x-ray 3 days after the injury, would it show up now? If it is not a fracture, what else can be going on?

    Thank you!

  103. I broke my left hand ulna and radius bone in a bike accident.. I am 28 years old. They have fixed my bone with DCP and screws on both ulna and radius bone.Now its almost 6 weeks and the cast is put below elbow. Doctor said that he will remove the cast after 2 weeks. Can i ride the bike after my cast is removed. I would like to know when the DCP will be removed from my hand? Is there any harm if it remains in my hand? Will they operate again to remove the plates? Please let me know in detail. Thanks…

  104. @Satish Nayak,

    Plate removal is not advised if it does not cause a problem.

    If required it is recommended that a plate should be removed after fracture has healed completely and that is usually 1-2 years.

    Yes! There would be repeat surgery of the same magnitude and you would need a cast for 6 weeks to protect the bone after plate removal lest it might fracture.

  105. @LucyB,

    Fractures usually do not result in such symptoms and metatarsal fractures should be visible on xray on 3rd day. You said you have painful neuropathy. It is possible that that has worsened.

    Morton's metarsalgia is another possibility.
    Discuss it with your doctor. Another xray can help to confirm fractures.
    I hope that helps.

  107. @B Srinivas Rao,

    The plate does not cause any harm as such. It needs to be removed only if it is causing discomfort.

    Swelling would go by and by.

    You are doing quite fine. It is not good to be apprehensive.

  108. I broke my fibula bone about 1-2 inches above my ankle on September 5th. ER placed me in a hard splint with bandage wrapping and next day my DR – she is a DO- . placed me in a boot type cast with Velcro and crutches and told me to come back in two weeks to see if it is healing correctly. Said if it is, I can ditch the crutches and start using a cast for an additiona two weeks at which time I can ditch the cast and just use the cane for weight bearing. Does this sound right? I am 54 yo female in relativeley good condition – I normally work out 3-4 times a week. When can I expect to be back at the gym? I am anxious. Thanks

  109. i got shaft of femur broken or u can say compound fracture.Intramedulary nailing was done in may 2009.now the doctors says they need to pull the screws one each from both end as the fracture site stills lacks union, its over four month.Well i have no problem in walking without support ( although a little limping is there).

    Should I go for that operation?. Is it needed? will it be a beneficial one?

  110. @Jacki,

    Line of treatment seems fine to me.

    You can still work out on rest of your body.

    I hope that helps.

  111. @ajitendra,

    If the fracture has not united, the nail is taking all the weight while you walk. One day nail would fatigue and will not support your weight.

    Before that happens, your fracture should unite.

    Pulling out screws would allow the gap between the fractured fragments to close and therefore enhance the chances of union.

    But usually we remove them only on one end.

  112. yes I broke my metacarpal # 4 going on 2 weeks ago and have had a cast on now for a week with my middle finger,ring,and pinkie pinger enclosed in the cast with it bet due to the slight rotation of the bone. My questions is , should I still be feeling a noticeable pop in my hand where I broke it? Also the swelling is very noticeable with great pain. Do you think I need to go have the cast cutoff and have the xray taken again to see if i need to have it pinned or plated?

    Thanks!

  113. hi doc, i have a stress fracture of the second metatarsal shaft. the alignment is fine so i was place in aircast end of may. The onset of pain was mid may and i am still in aircast and it is now September 24th. The orthopaedist took xrays and said everything is looking fine and i should keep the aircast on and use crutches so i dont put weight on the foot. sometimes i dont use crutches around the house because i have to do things for my little daughter. when do u think i will be fine. Its already been 5 months and i am fustrated and depressed. the foot(r) swells if its hanging and sometimes there is some tenderness. is it normal for a second metatarsal fracture to go on for that long? Help!

  114. u should know i got this fracture after i increased my running by 4 km. its a stress fracture the Orthopedist said.

  115. @Chris Ivie,
    Your doctor must have had an xray after the cast if the fracture was originally displaced.

    If that position is acceptable, it is unlikely to change unless strong forces are applied on the hand.

    If it was undisplaced tobegin with, it is even more unlikely to get it displaced.

    The swelling could be due to callus formation.
    In any case surest method to confirm the position is the xray and you do not need to remove plaster for that.

  116. Thanx Sir,

    Sir you mentioned about the nail get fatigued (If the fracture has not united, the nail is taking all the weight while you walk. One day nail would fatigue and will not support your weight.)

    so what should i do to avoid this?

    how much time is needed for the fracture to unite( its already 5 months and still there is a gap of around 1 inch)

    well i have no other disease per se. i am 24 yrs.

    Do i need to consult any other orthopedic surgeon.?

    should i go for dynamization?

  117. My son who is 12 broke his spiral break to his tiblaabout 3 weeks ago. Could you tell me why we still have pain and still take pain pills. Also his toes still swell. Do you think they should put a plate in there. Please give me your opionion.

    Thanks

  118. hi doc i just wanted to know if i should heel my broken finger i went to the docotor and he told me i need to see a orthopedist but i think that is a waste of time cause i need to stay at work or i will lose it for broken finger but i can still move it not all the way i am exercise it everday and i think its getting bettter so should i let it heel on its own oh yeah and the reason of the broken finger is cause i was finger wrestling thank you

  119. Hey Doc!

    This is just an update and a couple of questions. I went to my last appointment almost a month ago and my foot is healing quite well. I have been given a walking boot with the instructions to use my crutches if needed.

    The foot is feeling fine and doesnt hurt at all but my ankle swells up and is very stiff if I do not use it for long periods of time. Could this be fluid retention? My ankle only hurts when I twist my foot. Do you have any suggestions as to what I can do to ease the swelling? P.S. When I sleep the swelling goes down but it is harder to walk on my foot. Is that normal?

  120. @ajitendra,
    Please discuss the options with your treating doctor. you are free to take second opinion anytime.

    If there is a persisting gap you need to evaluated for treating that, most likely with surgery.

  121. @Eva,

    A stress fracture should heal within a month and if the symptoms have persisted this long, I think you should discuss with your doctor.

    It should not be tender after 5 months if it was stress fracture.

  122. @bigboy,

    Please see a doctor so that you can be diagnosed properly and get treated accordingly.
    Symptoms would get better in spite of lack of treatment but may lead to residual dysfunction.
    It is better to invest some time for your own sake.
    good luck

  123. @WillJam,

    This happens in ankle and foot injury. avoid prolonged standing or sitting with foot in dependent position.

    The swelling is due to inefficient drainage of fluid in presence of gravity. This is a common phenomenon and may take quite some time to go.

    Gravity can be avoided by keeping your foot on table or stool when you sit.

    In standing and walking it is unavoidable but can be minimized by avoiding continuous standing or walking.

  125. 2 weeks ago I fractured a metatarsal when I sprained my ankle…the pain I have now is different. If I hold my foot and ankle perfectly still it will be fine,, but if I am up and moving around in the boot and on my rolling cart, it feels like muscle spasms in my foot and up into my leg..the only way to relieve it is to take off the boot and hold it perfectly still and if I can take a vicodan. Is this normal? I have never broken anything before.

  127. @Barb,

    It might be that your boot is not immobilizing enough during walk.
    Please talk to your doctor.

  128. A couple of days ago. Me and my friend(s) were messing around on the field at our school…. We was rugby tackling each other, he was slightly heavier than me and he fell on my leg. I heared a big "Crack", So i paused for a seconed. and i noticed my left leg really hurt. So they forced me up and tried taking me to the medical room when we got half way there, a teacher came and dealt with it from there. I had an ambulance to our local A&E (Milton Keynes General) I was in there from 1:30pm to 5:45pm. I got X-rayed and i got told i had a break on my left leg (The seconed biggest bone in the body – Between my Ancle and the underside of my knee) i got put into a cast for 1 week to see if it got any better, it didn't so i had that cast removed, and i am now in a permanant cast for 6 weeks…

    The only main thing i would like to know, is….

    …will it heal and go back to it's normal strength if not stronger?

    Bottom line – Hey what are friends for…..?

  129. Hi Dr. Singh,

    I injured my foot last week Oct 9. The official result of the x-ray for foot injury is "Undisplaced fracture of the base of the fifth metatarsal". The doc said to continue with pain medication if I need it (I'm not in serious pain, but am facing discomfort) so I am not taking any pany killers. Doc also said to continue with rest, ice and elevation and to tape the last 2 toes together and that it should heal within 4-6 weeks, possibly in 2-3 with very good care. No cast given, no crutches given. I have been working from home this week, but doc said it's okay to go back on Monday the 19th as I work in an office and am not on my feet all day.

    However, I have been looking at various internet sites and researching on my own – I'm getting mixed messages for injuries of the fifth matatarsal – some a cast is required.

    What is your opinion? Is it normal not to receive a cast or splint or anything for this kind of injury? Please advise – thanks.

  130. Hi,

    My 12 year old son broke his arm just above his wrist the radius and ulna Bones about three weeks ago during ice hockey practice. The doctor did a closed reduction to get the bones back in place. The bones aligned good and he is now in a short arm cast for 4 weeks. He wants to get back out on the ice and skate but if he falls can he rebreak the arm in the cast? Also in 4 weeks they will be removing the cast if he would wear a good arm brace while skating would that protect his bone if he fell? Any input would be helpful.

    Thank you,

    Ken

  132. @Karen,

    the treatment varies from fracture to fracture and person to person.

    I generally prescribe splint but the fracture can be treated otherwise if not associated with displacement or severe soft tissue injury

  133. @Ken Barbusca,

    A newly healed fracture does not have the strength of the original bone yet.

    A brace does not protect against major trauma.

    My advice would be to avoid falls at all. That might mean avoid skating for few months altogether.

  135. i suffered fibula fracture lower 1/3.There is no twisting of ankle in it.The bones have not seperated n its a hairline fracture.i am in cast 4 seven weeks.I am serving in army n i wana know if by end of december I will be able 2 return to full duty?after that I can manage 2 months leave in feb n march next year.Will it be fine totally by then?

  136. Hi,

    I broke my 3rd & 4th metatarsals f weeks ago- the 3rd was slightly displaced but not operated on .

    I had the cast removed this week consultant stated that there was no point in re x ray. the only advice I was given was to start weightbearing with crutches when ever it was not painful -however it is really painful, much more so than when in plaster, I can put the foot down, but not stand weightbearing in any way and cant get shoes on – I have no idea how long it may take to get back on my feet properly, I work as a nurse and obviously there is pressure to get back to work but I cant estimate how long this might take. I would appreciate any advice, I have purchased an aircast and I can get around with this and crutches for a few minutes.

  137. Hi Dr. Singh,

    I had a bad fall while roller skating with my daughter and had a lot of pain in my leg. I have been to the doc
    two days later and got a x-ray done to find that i had a proximal fibula fracture (not sure what it means..but know its a broken bone)…Doc gave me a walking boot and said to use crutches if needed. Two weeks later had a follow up visit and Doc said that it has not displaced and it might heal and no need for a surgery. And told me that i should try put some weight.. i stopped taken all pain killers… no i am having pain while moving my leg up and down straight..is this common.

    in the mean time my ankle and fingers have swollen..i am not sure if the treatment is right ..i mean without the cast..just with the boot ( btw i am removing the boot in the nights at sleep and for shower from 11days since i got the boot as per doc's advice that i can do it)…i this all right

    Really appreciate your help

  138. @alok,

    Fracture fibula does not cause much problem as the bone is not weight bearing. Most of the weight is borne by other bone-tibia.

    As you have just a hairline fracture, you should be better in 4-6 weeks.

  139. Fibula is the smaller bone of the two bones. Proximal end is the upper end of the bone near the knee.

    You seem to be progressing fine. Things would get better with time. Ankle swelling can occur if foot is kept in dependent position. Try to keep it elevated when you sit. A chair or stool would help.

  141. @Jo McG,

    First thing to know is whether fracture has united or not. Especially if it is painful. Surest way to tell is Xray.

    If fractures have united your symptoms would improve over next few weeks.

    P.S. I am sorry I missed answering this before. Your second comment was similar so I have not published it. Anyhow that made me look whether I answered your earlier query or not.

  142. (plz ref my querry dated Oct 26th)

    thanx a ton doc..For how long should I take physiotherapy after the cast is out

  143. Hi Dr. Singh,

    5 weeks ago I broke my clavicle playing football. It happend in such a way that it is broken just over halfway along the bone but at the end closer to my shoulder. The bone coming from my sternum is raised upwards and the bone from my shoulder is touching at the bottom of the part coming from my sternum (such that it forms a upside down 'v' like shape. Most of the pain has gone and i have wide movement back, however i have not developed the lump associated with new callous formation and indeed my x rays after 2 weeks showed no new bone formation ( i was told this may be normal due to early stages and lack of calcification at that stage?). Occasionaly i can feel like a clicking from the bone that is painless. Do you think its a possibily that it is non union and if so is it still an early stage by where bone may form (if it hasnt already)? I am told that if it is non union as it is slightly raised it would be dangerous as it is not supporting my shoulder. I am just concerned about surgery in the main.

    Any help would be much appreciated

  145. @Ags,

    Non union is less common in fracture of clavicle but can occur.

    It is too early to call it a non union.

    Get an xray after 6-8 weeks of trauma and it would be better revealed if fracture has united

  146. Hello, Dr Singh.
    I have a comminuted fracture of 5th metatarsal Oct 14th. I have been wearing a walking cast ever since. On the 4th day post injury, I was able to do full weight bearing with my cast on, and was pain free, except for occasional pinch or shooting pain for 3 secs only. On the 3rd week, my calf muscle started to have cramps.
    Do you think I am healing well? What is the cause of my shooting pain…impinged nerve? muscle cramp from muscle tension? I took off my cast with good relief and massaged my aching muscle.
    Any in put is most appreciated.

  147. Broke my wrist on the 5th August 2009, straight break on the hinge, not sure what else to call it:). Plaster off on 16th September, still have pain and stiffness in my wrist, although I exercise daily. I am a learning disability nurse and I am unable to have contact with my patients as I am unable to do the management of training and aggression course. How long will I have to wait for the pain to reduce and my wrist to get back to normal? As there is no shape and it still swells up on a daily basis, I cannot carry heavy objects and I am very frustrated at not being able to work with my clients. How much longer will I have to deal with this? And will I ever do cartwheels and handstands again:) thank you

  148. Hi Dr. Singh,

    I had a Galeazzi fracture and the radius was set 9 weeks ago with a plate and 6 screws (I fell from a standing still position on rollerblades).I am concerned about several things now at this stage of healing process (my Dr. is not very communicative for me). I am a 48 year old helathy, physically fit petite woman.

    1) He said that X-rays at 6 weeks showed that bone 'hasn't healed'.

    X-ray at 8 weeks showed "some healing'.

    I also noticed in the 8 week X-ray a round swollen -looking white area around bone – is this soft or hard callus formation or somehting else ? Is this a stage that healing should be in now /normal progression or is it slow ? I'm afraid of non-union happening.

    2) Also, I have pain where the fracture is when I write for short periods of time from the pressure of bearing down with a pen. Is this okay ? Does it help the healing (increased blood flow?) even though there is pain ? Or does this mean I should not write because is detrimental to the healing (I need to for work sometimes) ?

    3) The dislocation of the distal ulnar joint is prominent and I don't think it looks normal. First Dr. and 2nd opinion don't say much about it – just wait and see if when ligament/tissues under it settle down maybe it will get better. What can be done if not ?

    4) I want to have the plate/screws removed when possible because I am thin framed and very active and one of the screws is visible and prominent. I am afraid about possible nerve or other damage that can happen from the removal. How safe would it be ?

    5) Concerns about arthritis, does this always happen ?

    6) I am 48 years old in excellent physical health, should i still get a bone density scan due to these circumstances ? My Dr. says I don't need one until 60.

    Apologies for so many long questions but I am so nervous about all this – I appreciate your help.

  149. @ 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?

  150. 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.

  151. 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?

  152. @coral,

    What bone was exactly involved.
    Was there an associated ligament injury?
    Have you got an xray after injury.

    As wrist contains many bones and you did not mention it, so I need to ask.

  153. @Susan,

    I understand your nervousness and concern. It is not an unusual thing. We all get worried about ourselves.

    I do not have your xrayu pictures to look at. So my answers are based on deuctions I made from your description.

    At any given time a doctor whom you can visit physically especially your treating doctor is in position to answer them better.

    1) After a rigid stabilization as in your case fracture healing may not be visible on xray for long time as callus formation may not be there.
    But some amount of callus can also be seen. You can read more about this here https://boneandspine.com/fractures-dislocations/pr…
    What yuo describe seems to be a hard callus.

    2) Pain in fracture site may occur and it varies from one individual to other. Your this activity per se should not affect bone healing either way.

    3) Usually after radius bone is fixed in Galleazi fracture, the distal radio ulnar joint gets back into its position. I need to look at the image whether it has relocated or not. If you wish you can send me one.

    4) Plate removal is not advised before 18-24 months. It would not cause any problem if it stays there. the removal is advised only in case of problem.

    It would be a surgery of almost similar magnitude and you would need your limb to be protected in a cast for minimum of six weeks.

    So I would advise not to think about it if you are just wishing to get it removed without any other reason.

    5) Per se not if the joint has been relocated.

    6) There seems no need for that as your doctor advised.

    At present the first goal is fracture union and that should be main focus.

    I hope that helps. All the best.

  154. @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.

  155. @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.

  156. @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.

  157. 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.

  158. @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.

  159. 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.

  160. 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

  161. 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

  162. 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?

  164. @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.

  165. @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?

  166. @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.

  167. @ajitendra,

    The metal with repeated loading looses its strength at some point of time. This is called fatigue.

  168. 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?

  169. @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.

  170. @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?

  171. 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…

  172. @stevecatalan,

    The alignment looks fine. You need to wait for signs of union.
    Good luck.

  173. @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.

  174. 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?

  175. 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.

  176. 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

  177. 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…

  178. 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?

  179. @Susan,
    It is often difficult to establish a cause of non union. You can go through this articles for list of causes https://boneandspine.com/fractures-dislocations/co…

    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.

  180. @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.

  182. 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.

  183. 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

  184. @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.

  185. 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?

  186. 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

  189. 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

  190. 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?

  191. @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.

  192. @S Subramaniam,

    6-12 weeks is the usual time for union. Compound fractures may take longer.

  193. 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.

  194. 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?

  195. 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.

  196. @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.

  197. @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.

  198. @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.

  199. 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.

  200. 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.

  201. @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?

  202. @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.

  203. 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.

    **************************************************

  204. 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 ?

  205. @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?

  206. @Susan,

    When your doctor says that, he/she is talking about implant failure. I have slightly touched this issue in this article
    https://boneandspine.com/fractures-dislocations/hu…

    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.

  207. 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

  208. 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.

  209. @yogesh,

    Is it really 2CM or it was a typo.

    2 cm gap would not unite in any case until it is reduced.

  211. @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.

  212. @yogesh,

    Then, you appear to be treated rightly. The primary aim is to reduce the gap and stimulate bone healing by grafting.

  213. 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?)

  214. @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.

  215. 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.

  216. 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.

  217. @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.

  218. 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.

  219. @Fahad,

    They could be but it cannot be said for sure.

    Only confirmed way is to look for clinical signs and xray.

  220. 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?

  221. @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.

  222. @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.

  223. 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.

  224. 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.

  225. 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

  226. @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.

  227. @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?

  229. 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

  230. 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?

  231. 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.

  232. @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

  234. 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?

  235. 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.

  236. 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.

  237. I have broken my humerous mid shaft it was a clean break no nerve damage as I can move fingers and fist but it has been 2 weeks now and I still can't move my arm up and down my doctor seems really happy with x rays he says it is straight and gap is decreased, but I really want to know when I will be able to start moving my arm doc says 4 weeks I will be able to take humuroeus brace off. What do you think?

  239. I was put on surgery 10 days ago for a nonunion of the bones on my second toe of the left feet. I have two pins inserted but last night on of them fall out of the toe. Should i go to the hospital oris normal considering th resent surgery?. Tks for your help.

  240. I got neck of femur fracture gardener type 4 and surgery was done after 30 hrs of accident. My doctor recently said there is collapse but still it can union. The screws fixed came a little back because of collapse. What does it mean and how bad is it? The surgery was done about 3 months back and now I am walking with 50% weight on the leg. For how long more you suggest to use cretches. I am having some discomfort in the groin area sometimes. I took about 10 phisiotherapy sessions about a month back and now not doing any physiotherapy. I am travelling by Auto since last 15 days and is it OK. Do you suggest to take any cautions?

  241. I also have swelling on the the foot since last 2 months. Do I have to do something for that?

  242. @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

  243. @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

  244. hello doc i posted once before but it was removed i am not sure why, my problem is i broke my humureus mid shaft clean break no bones peircced through the skin, the doc put me in a u slab for 1 week and i have been in a humureus brace for 3 weeks, last x ray was at week 2 which showed good allignment doc was very happy and said i would be able take brace off in further 4 weeks, where my problem lies is that i do not have any control over my right arm, i can move my fingers, wrist and write feel everything along my forearm can rotate my shoulder but i can not move my arm up or down or let my arm rest without a sling as i feel a great sensation of pain near my bicep and elbow, could you please tell me if its normal and when will i gain sufficient control of my arm. thanks in advance

  246. @Imran,
    A fracture takes around 6-8 weeks to heal. Following that you would need to work out with physiotherapy.

    Probably another 15 days.

    Good luck

  248. @kishore,

    Collapse is occurs because the head settles on neck as you bear weight.

    It is not a bad thing.

    Crutches should be used till union.

    I do not think traveling by auto is going to do anything.

  250. Hi – I have a spiral fracture of the upper humerus. It has been 8 weeks since the injury. I was x-rayed after 7 weeks & the bone is aligned; however it is not showing signs of forming union. Does it need surgery to heal? I have been told that they will x-ray me again in 4 weeks as "there is no point in x-raying me sooner". How long will it yake before they decide to try surgery.

  251. hello, i got 5th metarsal rt foot fracture on march 27, 2010 and was casted on 6th april for 1 month. I consulted Dr. for healing, he said healing is ok. But still i m having swelling on rt. foot while walking / sitting. Pl. advise

  252. @Deb,

    I think they would make decision next week. If bone has not attempted to unite till now, it is less likely.

    Have a word with your treating doctor when you meet him next time.

  253. @sukhjinder singh,

    Swelling is different from bone healing and can continue for a period even after union.

    It would go with time.

  254. Had a compression plate installed on my left humerus in Jan after a midshaft displaced fracture in Nov. Am thinking I might want it removed if I'm still aware/bothered by the sensation of the hardware next Jan or so.

    1. Is the removal of the plate and its 6 screws much simpler/safer than the initial install?

    2. Is the chance of a re-break any more or less likely after removal? Intuitively, I thought that the plate gives additional protection from that, but now I'm not so sure. Both ends of the plate seem to form a pair of fulcrums that could increase the chance of new breaks at those points.

    I'm a fairly active 66 year old who engages in manual labor like mowing, weed-eating, fencepost driving and tractoring, so I'm subjecting the arm to some fairly jolting, jarring activity.

  255. broke upper humerous clean 3 weeks ago. Is on and off pain normal,? Is there stability in the boes already as currently there is no displacement and wonder how easy they could become displaced? I worry it could shift while sleeping or walking but this might seem crazy? Also, is swelling still to be expected in my forearm?

    Thanks

  256. @Bill Stacy,

    1. It is almost a surgery of same magnitude though the duration would be shorter.
    2 Yes! You would need to be in plaster for 6 weeks after removal. The screws removed would leave holes which weakens the bone. Hence the protection.

    I hope that helps.

  257. @james bartsch,

    Too many questions but little information to help me to deduce an answer.

    What is your age?
    What treatment has been given?
    What is level of the fracture?

  258. i Thought i should leave a little update if you scroll to the top you will see i broke my humerus mid shift clean break, my docs decided on self healing so i had a u slab with a compression brace.

    I just wanted people to know it was a long recovery and still going on. initially i couldn't move my arm for 7 weeks, i tried many times but my arm wouldn't function little by little and i mean little i started moving my arm here after, baby steps weeks 8 -12 really week grip. 12 – 16 more free movement coming back but still find it difficult to lift stuff which weights a fear amount should be seeing my doc for final x rays to see how its mended. I personally think i have another 4 weeks before i can start some sort of proper exercise on it, but only on docs advice. i hope this helps anyone as i was worried reading horror stories about people not gaining any sort of arm movements or sensations for 6 months

  259. 37 yr old male, broke humerous just below shoulder, is not displaced, clean break. Have been in collar and cuff sling last 2 weeks, first 2 weeks u-slab sling. Just had xray, one day shy of 4 week mark, no calus showing yet. Should I be worried about non union and surgery or does it just take a few more weeks to show progress? Also do you have any nutrion tips to speed healing. I was a smoker but heard it hindered bone growth so quit 2 weeks ago, one positive from the fracture.

    Thanks

  261. Hi !!! I am wondering — how fast can a hairline fracture near the base of the fifth proxima phalanx takes to heal ?? I am asking under general condition with no stress added to it. Also do I need a big cast to wear??? I appled heat treatment on –at the very moment of the impact and Hirudroid cream that worked marvellously. The swelling and pain gone within 2 days and I sought a GP advise. He refer me to an Orthopaedic doctor for next Monday appointment and I am posting to you now during the weekend.

  262. @Melanie,

    On an average four weeks. An immobilsation is advised. It may not be in form of plaster but it is advised.

    All the best.

  263. Hi I broke my right fibula bone (lower leg) on June 20th 2010. It was a clean break with no surgery required. I was in a splint for 10 days and than a cast for 6 weeks. My cast was removed on Wed August 4th. The doctor said that my bone is not fully healed and i should only walk lightly (no jogging) on it for the next 3 weeks until my follow up appointment. It still hurts and I have a burning sensation at night. Is this common to let someone with a broken bone to walk on it with no cast? Is it possible to delay healing or cause more injury within these next 3 weeks? What if my bone is not healed in the next 3 weeks? Will they put another cast on?

    Any reassurance will be much appreciated.

    Thanks

  264. Hi Doctor,

    I fractured my fifth metatarsal on my left foot. I'm in an aircast as of now, and I have a boot that i put on when I go to sleep. I've noticed that after two weeks, I have a weird, painful sensation where the fracture is. I can't describe it, but it's just a quick jolt when I move my foot in a weird position in the cast.

    Is this normal during a fracture heal?

  265. @Anna G,

    If your bone has healed enough to take the cast out, I do not think you can injure it with your routine activity.

    And if it is healing, it should further heal with time.

    Let me know.

  266. @Robert Y,

    A cast annot give you 1000% immobilization. Therefore it is advisable not to put your foot in weird position.

    Whenever you move the fracture or attempt the movement, it would pain.

    Take care.

  267. fibula fx undiagnosed for 10 months. non-union with large gap, no bone. surg. done/debridement+bone plate, screws. developed non-healing wound which started first day surgical sutures removed with seepage near ankle area. many debridements of this open wound with pale, yellow drainage went on for next 8 months and 5 rounds of deifferent antibiotics for all this time(on bactrim x 35 days at present b.i.d.. Ha surgery #2bone plate removal and more fibula bone necrotic so removed more bone and cannot have a plate again. now diag. with osteomyelitis. lower leg gets purplish blue and turns snow white when push on skin with fingers. when up all day, ankleg, lower leg swells. developed lg abscess at fx site and had to be milked at top of old surgical incision which went down and pus type fl. came pouring out down at bottom where open wound hole was. fib. bone culture showed staphy. auerus and deep tissue culture showed staph. lugdunesis. now, it's been 6 weeks since emoval of plate, screws and see hole at lower leg where chronic non-healing wound is trying to come back along with a 2nd sunk in area which looks like maybe a 2nd hole opening will eventually appear. Questons: what will be the negative affects of a large area of no fibula bone, lower third of leg cause as far( as running, jumping, twisting body around to look at something, stooping to the floor, using treadmill, long ex. walks, etc, and can you think of any other things wihich may change in my life besides these?).

  268. forgot to say had hip bone grat on first surgery which was mostly eaten up when they went in on 2nd surgery and this all was debrided with extra fib. bone removed to healthy bone. will the germs get into my bone left and can it develope into a sinus tract and get over into my tibia eventually?

  269. I got my fibula fractured on the ankle 7 weeks back,still the cast is there.There is also a crack in tabula on the ankle. How much time it will take in bone healing and do I need physiotherapy after the cast is removed. when will I be able to walk normally without the walker.

  270. @sandy c.,

    I need to know the level of the fracture. A recent xray would be helpful.

    What are the problems that you are facing in your daily routine life.

  271. I have had a tibial stress fracture since April from overtraining. I have not been running since and am now in a boot and there is still no change. I am taking a calcium supplement with 500mg of calcium and 500iu vitamin D twice a day. Is there something more I can be doing to help speed recovery?

  272. Broke collar bone 5 weeks ago – bone slightly attached – had x-ray last week and no sign of any callus forming – x-ray was not much changed from original x-ray. Am I worrying too much?!!

    Thanks

  273. @Anu,

    Fracture generally heals within 6-8 weeks in most cases. It is followed by pohysiothearpy which may take other 2-4 weeks.

    All the best.

  275. @Graeme,

    No! You are rightly concerned. Absence of callus after this period might suggest that bone is not uniting.

    Speak to your doctor if another xray after 2 weeks shows the same

  276. Dr. singh i broke my metacarpal bone from punching a solid object with a closed fist. from what i remember the dr said it was shattered and that i would need surgery . the fracture happen i believe on the 4th or 5th bone also sometime called boxers fracture. i wanted to know what if i didnt do surgery what is the possibility of it healing on its own if i keep a splint on?

  277. my maid who is 18 yrs old , got a bullet pierced in her left forearm. x-ray revealed the bullet to be stuck in ulnar bone.doctors put a splint and bandaged her forearm saying that the bullet cannot be removed as she is 4 months pregnant.

    why cant the bullet be removed?

  278. @ahmad,

    Metacarpal fractures usually unite on their own too but surgery is advised if the position is not satisfactory.

  279. @yasha younes,

    Bullet is a foreign body. But leaving it as such does not cause any problem due to its inertness.

    Second trimester of pregnancy is relatively safer to get any surgery. But any surgery does subjects the foetus to extra risk during entire period of pregnancy.

    Therefore most of doctors recommend and do only surgeries which are necessary.

    The choice of surgery in your case is entirely dependent on the decision made by the patient after understanding the risks involved.

  280. Hi Doc, My Tibia and fibula is broken due to road accident. Got operated by inserting Titanium rod below knee joint till ankel. It has been almost 4 week now. I just wanted to know how much time it will take to get completely ok. And the rod is only used to joint my tibia and not fibula. Does Fibula get joint or alligne automatatically.

    Pls reply

  281. Left forearm of my son, broke on 12 june 2010. He was operated at Rawalpindi Pakistan on 17 june 2010 and two plates were fixed . Now after three months of operation one bone is sufficiently healded while there is gap in eluna where some grafting was done . How long it will take for the gap to heal.

  282. Hi Dr, I am 43 year old woman, with 3 hairline fractures on the ball of my right arm humerus. It occured on Sept 3,2010. I am using the sling as advised. The shoulder specialist advised me on Sept 17th to start rotating my arm slowly. Everyday, there is new pain in my upper right side. I do the in home physio as directed but am worried that i might injur the callus! Has the callus formed already? I don't have any displaced segments. How long should it be until full recovery?

    thanks

  283. My aunt has a gap somewhere in her spine. As a result, she has constant pain, can't walk and has to be careful when she sits, walks, etc. She had an X-ray some while ago – that's how she found out she has a gap in her spine. Now she's so worried, she keeps on crying non-stop. What happened to her? Would her spine heal by itself or would she need to go through some kind of surgery? I'm just looking for some advice so that I can comfort her once I know that she's not going through a horrify thing.

  284. @Vasim,

    Completely OK is avery relative term. In case of fractures we are concerned with union of bone which would take around 8-12 weeks.

    This is followed by a period of rehabilitation which again is variable with different people. Usual duration is 4-12 weeks.

    Most of the people are able to get back to their chores by this time.

  287. @Haj,

    Gap in the spine does not suggest any meaning. You would need to elaborate about her condition.

    Rather, you should visit a specialist and seek an opinion.

    Gap in the spine is a loose term that makes no sense at all even if it was used by a doctor to explain some process in vernacular language.

  288. I broke my right distal radius. How long should I put ice on the cast to help with swelling? Do you ever use warm compresses to reduce the bruising? Thank you?

  289. Hi, i have a distal phalanx fracture in my great toe. Was put into a half cast for one week and the ortho doc says i can walk without immobilization already? It has been 3 weeks since the accident and now i can walk without pain at all.

    But my concern is when i bend my great toe to a certain extent, it kinda hurts. And when i press on my great toe, i can actually feel my distal phalanx 'moving' or 'grinding' against each other. Is that how a non union feels like?

    Today marks the last day of 3 weeks. Tomorrow will be the starting of the 4th week. The ortho doc had scheduled another x ray appointment on the 6th week.

    So should i be worried now and go for an early x ray appointment or should i wait for the 6th week mark? And is the pain when bending too much of the toe and the feeling of the fractured bone 'grinding' or 'moving' against each other normal?

    Hope to get a reply real soon Mr doc, millions of thanks in advance.

  290. Dear dr Singh I have fractured my 5th matartarsal and it’s a hairline fracture no disposition or anything my foot is wrapped in a soft splin it isnt loose fairly snuggled with 2 layers I wonder is that good enough? I also have a cam cast boot but only wear it when I decide to step outside I am 6’6 290 what’s the best thing for me to do ? How long would you guess or believe it will heal?? It wud be nice if you could answer those question

  291. Thanks for the response Dr. much appreciated. I am able to make bigger circles using my shoulder joint. There is still heaviness and stiffness in that area. I have another clinic appt on Friday the 15th. How long do you think it will take me to get my normal arm back? This is my dominant arm and I can't do much with my left hand.

  292. I crushed my right thumb at work which resulted in a complete open fracture of my distal phalanx, it is not affecting the joint, just the top half is broken in two. I had a splint on for 2 weeks with daily dressing changes. I went to the doctor to get my stitches removed and the xray was similar to xray the day of the accident, there is still a 2~mm gap between bone ends. Is it normal for there to be little repair in 2 weeks? whats the worst case scenario? thank you

  293. @Stephanie,

    Did you visit a specialist?

    In set of acute injury warm compresses are not recommended.

  294. @ricky,

    A fracture usually takes 6-8 weeks to heal. I think you are doing fine.

    Your fragments must have started to unite but their may not be enough strength in the union which would come gradually.

    Its 10 days since you posted and I could not answer it before.

    Sorry.

    How are you now?

  295. @Carma,

    A hairline fracture should heal in about 4 weeks. You are being treated adequately.

  297. @Anthony,

    2 weeks would not show any radiological changes.

    Get an xray after two weeks.

  298. Hi, thanks for your reply!

    I am doing great now, no more feeling of the grinding or moving of the broken bones when i press on it or walk on it. But when i extend my leg straight and bend my big toe, i still can feel something in my great toe, is that normal?

    3 more days and it will be the starting of week 6. And I cannot really bend my toe all the way back.

    Hope to get a reply soon!

  299. I broke my ankle where the lower end of the femur connects to it. No surgery all i was given was an aircast. It has been 3 weeks since the fracture and was wondering if the swelling that is still present is normal. I am able to walk now but my ankle is still kind of stiff without the aircast on. Thanks

  300. Hello Dr. Arun,

    Two weeks ago I've fractured my right ring finger bone. See link for x-ray image.

    The doctor gave me 2 option to cast it or a surgery installing a pins. I choose to cast it. If you can see the x-ray image above, the bones were not properly align. What should I do? Should I undergo surgery with pins or let it heal on a cast?

    If I let it heal with a cast, what kind of problem should I occur?

    Thanks,
    Don

  301. Hi, i fractured my fibula, but it was stable and did not need surgery. i had a fiberglass cast put on Monday but it feels tight at the arch of my foot, i get a burning sensation and pain at random times. i went back to hospital on thursday about my concerns but they said it was not worth taking the cast off becase it would be too lose, they just said to keep my leg elevated above heart..i have been keeping it elevated but it still hurts and still getting the burning sensation, should i go back and get the cast changed? ? thanks

  302. Dear sir, I need your advice in case on my mother, she is aged 71, she fallen down at home 5 weeks ago, since then she is undergoing treatment by orthopedic, giving her pain kiler medicine and protin, vitamin, calcium etd. and diognised as compression in vertevrea namely D-10 & D-12, she has constant lower back pain both side but more in right side, she has also stomach problem and toilet going is very irregular, stool does not pass up to 3 to 4 days, our doctor suggests kiphoplasty if there is no relief in pain, what should I do ? she has bed rest but pill is not working to relief from pain, also reducing the body, please guide me, is it possibe to cure by medicine and rest ? or any other non operative treatment is there ?

  303. Hi Dr.

    I sprained my ankle from a fall ( I jumped off a high deck in the dark) & was examined with a nondisplaced oblique fracture on the most lateral aspect of the dome of the talus. The tibiotalar joint is intact, there is lateral soft tissue swelling. I am a 32 year very active male.

    So I got an x-ray 7 weeks later as a follow up and the x-ray came up unchanged. These were seen by 2 separate radiologists. I got an a opinion from an orthopedic Dr. a few days ago who looked at the x-rays and said there is healing occuring although he feels there may be a trimalleolar fracture and maybe a ruptured tendon. He said he does not think that surgery is needed, if anything to clean things up but that he does not feel that's necessary since things look okay and that I am doing what I need to be doing staying off of it.

    He recommended getting a cam walker or air boot to put my foot in.

    He also said that I would have pain for 6 – 12 months but did not give me a time frame for complete healing. Also, I was told not to weight bear (which I have not, I've been in a splint and on crutches for almost 8 weeks now) but that I should start moving the ankle around like doing the ABC's to prevent fibrosis. I am going to another orthopedic Dr. in 2 weeks for another x-ray and get a second opinion.

    I just want to get your opinion on how long healing may take until I am 100% & the fact that what I am reading about trimalleolar fractures (if that's what I have) usually require surgery.

    Thanks, I appreciate your feedback.

    Tom

  304. @ricky,

    I hope you are quite better now. I try a lot but somehow could not reply early.

    Its bad habit but had been really busy with few things.

    Sorry.

  305. @Cameron,

    Something is wrongly stated. Femur bone does not come to ankle.
    Is it Tibia you are talking about?

  306. Hi I posted a question about a month ago, and I have an update.

    It has now been over 6 weeks since I received a tuft fracture of my distal phalanx on my right thumb.

    The X-rays show basically no improvement since the day of accident, the bone ends are STILL completely separated. Is this normal? the X-rays from day 1, 2 weeks and 6 weeks look all the same.

  307. @Tom,

    It is difficult for me to commend on your situation as I d not have the complete info.

    In fact what you say is bit confusing.

    First you mention that it was talar dome fracture. I do not think that can be confused with trimalleolar fracture as both the fractures involve different bones.

    Can I look at the xray?

  308. Sorry it is the Fibula that I broke. It has been a month now. I am walking normally it is still sore though when i try to jog and turn real fast. Is that normal?

  310. @Don,

    I do not why but your image did not load. How are things now?

    Add:

    Yes it did fianlly. Because the injury is near the joint, a fixation would have served you better.

  311. @Rajesh,

    Medicine and rest followed by physiotherapy are the mainstays of the treatment.

    Role of kyphoplasty is debatable but some studies have reported good pain relief.

    BTW how are things now?

  312. Dr Arun Pal Singh Reply:

    November 11th, 2010 at 12:16 pm

    @Don,

    I do not why but your image did not load. How are things now?

    Add:

    Yes it did fianlly. Because the injury is near the joint, a fixation would have served you better.

    ****************************************************************************************************

    So you see the x-ray image… Right now my fingers are stiff and I know it needs therapy. It's been 4 weeks now. I guess upon researching I found out that this kind of bone healing is a mal-union thing. It was not properly aligned.

    What are the effects of a mal-union on my hand? I mean what should I expect? Will this cause me problems in the future? Thanks.

  313. i broke my wrist (displaced fracture that was reduced and casted) four weeks ago.at the two week appointment ortho said xray looked good.had another appointment two weeks later (yesterday) and ortho decided to recast in long arm due to it being lose and keep me casted for full 6 weeks in a long arm cast (2 more weeks) and i have a few questions.forgot to ask the ortho.(have no xrays, sorry)

    1. how likely is it for the bones to shift out of alignment at this stage? and will occasional muscle spasms move them much?

    2.my wrist is casted in a bent position.he said it was to help keep the bones from collapsing.

    will my wrist be stuck in this position?

    when would be a ideal time to straighten it out?

    will it hurt as bad as last time (4 week mark) when it was removed from the cast next time?

    is a occasional burning sensation normal? i chalk it up as nerves.its not bad but annoying.

    i was thinking of asking them if they can just cut this cast down to make a short cast instead of recasting, granted my wrist area will still be tight.i dont want to risk harming the fracture prematurely at my next appointment when i get my short arm cast.

    thank you for your time.

  314. hello doc, i recently sustained a c2 fracture while in a car accident. i was wondering how long does it take to heal and how long do i have to wear a neck brace. secondly i sufferd a contusion to the elbow with a slight healing fracture, can that cause black blood to appear on my forarm with massive swelling while forming a scab and now from time to time has discharge? is the swelling why i cant bend my arm up to my face?

  317. @Don,

    Pain and limitation of the motion in the affected joint are the usual consequences.

    The severity of the symptoms vary though with individual.

  318. @sareena,

    The fracture usually becomes sticky around 2-3 weeks and with this the mobility of the fragments decrease with passing time.

    Do not worry at this time about shift f alignment.

    After your plaster is removed, you would be put on physiotherapy which would help you to regain the movements.

    whether to shorten the cast or not is a decision that depends on your fractur configuration and healing response.

  319. @remita barnett,

    A fracture usually would take 6-8 weeks to heal but brace could be advised for a longer period depending on your fracture configuration.

    Your forearm looks like having an infection. Get in touch with your physician.

  320. Hello – wonderful website.

    I injured my back 5 weeks ago by carrying a 30 lbs child up an unmarked hiking hill. Felt major "twinge" when I shifted the child from hip to hip. Since then, have been suffering with pain similar to the classic symptoms of sciatica: shooting pain down the back of my left leg, occasional numbness and tingling down my left leg and through my left buttocks. I absolutely cannot sit down for any length of time as that will completely exacerbate the problem, but I can stand and walk for hours on end without a problem.

    Had an MRI that only shows swelling at the tip of my spinal cord (conus medullaris). Very happy I did not rupture a disc. Now into my 5th week, the pain seems to be concentrating in my lower back and vary rarely are there shooting pains down my leg. I am careful not to do anything to tweak or shift my back in any way to cause further pain. Tried physical therapy (ultrasound, heat, electric stim) but it does nothing to help. Ibuprofen provides no relief.

    How long does it take for swelling of the conus medullaris to settle down and go away? Scheduled to see a neurosurgeon at the end of January but hoping it will go away before then. Thank you.

  321. My Husband is 27 year old. He is suffering from Bone Tuberculosis detected recently. As per Doctor, the disease has not affected his nervous system yet. Doctor prescribed him medicine of 6 months. Some people are saying that Bone Tuberculosis does not heal fully. There is chance of lead a good time in bed. How true it is? I am very tensed, can you please clarify? And what can I do?

  322. Hi Dr.

    Replying to your reply below. Actually I saw a specialist about this a week and a 1/2 ago. He is telling me I broke cartilage on my talus mainly, not so much a bone fracture. He told me there may be a small bone chip & to start walking on it (he told me I have the leg bones of an old women for staying off it for so long) with 2 crutches, then 1, then working my way to without any support. He has me doing the ABC's with my foot vigorously to get mobility back. Eventually he wants me to get to the point where I can do calf raises.

    I was told there could be swelling for up to a year, and that I may have long term pain. I am going back in a week and 1/2 for a follow up and possible MRI. The Dr. said it may be possible to perform a surgery to tack the loose cartilage back on but it is difficult to do and may not be necessary. He doesn't think I tore or ruptured any tendons but there is a lot of swelling still around my ankle joint especially near the achilles heel.

    Right now I am walking with a cane. There is a lot of pain when I walk on it everywhere in my ankle & foot, not just where the cartilage damage is and the swelling is causing my flexibility in my ankle/foot to be limited. There is no pain when I am sitting or moving it around doing the ABC's, just when I walk on it. What I am wondering is what is the approx. time it may take until I am fully mobile & can run, train in martial arts etc. & when can I expect my ankle swelling to go down to where it looks like my other ankle? Again it's been about 3 months 2 weeks since my accident.

    I can send you the x-ray, just not sure how to attach it to this post. Please let me know, thanks!

    Tom

    Tom says:

    October 27, 2010 at 11:16 pm

    Hi Dr.

    I sprained my ankle from a fall ( I jumped off a high deck in the dark) & was examined with a nondisplaced oblique fracture on the most lateral aspect of the dome of the talus. The tibiotalar joint is intact, there is lateral soft tissue swelling. I am a 32 year very active male.

    So I got an x-ray 7 weeks later as a follow up and the x-ray came up unchanged. These were seen by 2 separate radiologists. I got an a opinion from an orthopedic Dr. a few days ago who looked at the x-rays and said there is healing occuring although he feels there may be a trimalleolar fracture and maybe a ruptured tendon. He said he does not think that surgery is needed, if anything to clean things up but that he does not feel that’s necessary since things look okay and that I am doing what I need to be doing staying off of it.

    He recommended getting a cam walker or air boot to put my foot in.

    He also said that I would have pain for 6 – 12 months but did not give me a time frame for complete healing. Also, I was told not to weight bear (which I have not, I’ve been in a splint and on crutches for almost 8 weeks now) but that I should start moving the ankle around like doing the ABC’s to prevent fibrosis. I am going to another orthopedic Dr. in 2 weeks for another x-ray and get a second opinion.

    I just want to get your opinion on how long healing may take until I am 100% & the fact that what I am reading about trimalleolar fractures (if that’s what I have) usually require surgery.

    Thanks, I appreciate your feedback.

    Tom

    Dr Arun Pal Singh Reply:

    November 10th, 2010 at 10:34 pm

    @Tom,

    It is difficult for me to commend on your situation as I d not have the complete info.

    In fact what you say is bit confusing.

    First you mention that it was talar dome fracture. I do not think that can be confused with trimalleolar fracture as both the fractures involve different bones.

    Can I look at the xray?

  323. Hello Dr Arun

    I slipped in the office and had a fracture on the Ankle bone (fibula) on 12 October 2010, my Dr has asked me to get several x-rays to see if the bone has moved or not. Since the space between the bone has become less the Dr let me start walking from 14 November 2010. i have been walking ever since. I wanted to know about the burning sensation that i get (i walk with the fibreglass cast, but the cast isn't tight its comfortable for me) is it normal? what does the burning sensation here mean?, when will i be able to walk with out the cast?, will i be able to run or even jump anywhere sooner? Can i carry my 1 year old son n walk? can i carry any weight n walk(House work)? how long does it take to HEAL ?

    Appreciate if you could reply with the answers

    Thanks

  324. @Ann,

    Why should there be a swelling of Conus Medullaris?

    It is not usually seen and it cannot result from the strain that you describe.

  325. @Sadia Naznin,

    Please follow your doctor's advice and support your husband. Take care of his hygiene and nutrition so that he has enough strength to resist the disease.

  326. I am a 54 year old woman with a non-displaced spiral fracture of the fifth metacarpal of my right (dominant) hand. Injury occurred Oct. 2 or nearly 8 weeks ago. Spent 3 weeks in plaster splint, then fingers were buddy taped two weeks. X-ray at 7 weeks still showed black line and no visible healing. PA prescribed hand therapy for range of motion in fingers but exercises have increased soreness and swelling. Joint of fifth finger is stiffer and inflamed. Should I get a second opinion or is this normal healing process?

  328. i had a fracture in my right ankle.both the lower portions of tibia and fibia were broken.doctor made a cast and yesterday after 38 days the cast was removed.i want to know about the recovery time and what else i can do to start walking again and any other thing i can do for my treatment?

  329. Hi doctor., I have a fracture in 2 and 3rd metatarsal, and xrays and doctor confirmed, it is not displaced. Just a break and doctor had said it will take 3-4 weeks to heal… but on browsing the internet am really afraid, whether am in for a long haul… pls advice me regarding the healing time…

    It has been 7 days since the fracture, and i tried to move the fractured leg slightly, i walked around 4 to 5 feet, slowly with slight pain, and again i shifted back to my crutches.. I would like to know, by walking whether i would have done more damage to the fractured area or walking slowly for 3 to 4 feet daily is not a problem? IAppreciate your inputs..

  331. Hi Dr. Singh:

    As a follow up to my original MRI, I received my radiology report which indicates the following…

    FINDINGS: Sagittal sequences extend superiorly to the T10-T11 level. The 6mm x 6mm intradural lesion near the tip of the conus at the inferior aspect of the L1 level demonstrates fairly homogeneous enhancement. No other enhancing conus or spinal canal lesions are identified. There are no bony destructive lesions.

    IMPRESSION: 6 x 6mm intradural enhancing lesion near the tip of the conus. The leading differential considerations include ependymoma, nerve sheath tumor, and meningioma.

    My doctor is setting me up with a neurosurgeon. First available appointment is January 31, 2011. I was considering canceling since the pain and symptoms are really subsiding finally, but now knowing there is the possibility of a tumor, I'm going to keep the appointment.

    I'm now wondering if the tiny tumor has caused my sciatica symptoms in recent years…and maybe carrying the child up the hill in October really brought out the sciatica….and finding the 6mm x 6mm lesion on the MRI pictures was just pure coincidence.

    Any thoughts?

    Here was my original issue:

    I injured my back 5 weeks ago by carrying a 30 lbs child up an unmarked hiking hill. Felt major “twinge” when I shifted the child from hip to hip. Since then, have been suffering with pain similar to the classic symptoms of sciatica: shooting pain down the back of my left leg, occasional numbness and tingling down my left leg and through my left buttocks. I absolutely cannot sit down for any length of time as that will completely exacerbate the problem, but I can stand and walk for hours on end without a problem.

    Had an MRI that only shows swelling at the tip of my spinal cord (conus medullaris). Very happy I did not rupture a disc. Now into my 5th week, the pain seems to be concentrating in my lower back and vary rarely are there shooting pains down my leg. I am careful not to do anything to tweak or shift my back in any way to cause further pain. Tried physical therapy (ultrasound, heat, electric stim) but it does nothing to help. Ibuprofen provides no relief.

    How long does it take for swelling of the conus medullaris to settle down and go away? Scheduled to see a neurosurgeon at the end of January but hoping it will go away before then. Thank you.

    Dr Arun Pal Singh Reply:

    November 27th, 2010 at 7:28 am

    @Ann,

    Why should there be a swelling of Conus Medullaris?

    It is not usually seen and it cannot result from the strain that you describe.

  332. Thank you so much for this article, it was very informative. My 3 year old son broke both the bones in his right leg, about an inch or two above the ankle. he was sedated for realignment and was in a full leg cast for 7 weeks (no pins or anything). the cast removal took over 30 minutes (with him screaming in pain the whole time) and his foot and ankle were badly bruised. The x-rays, according to the orthopedic specialist, showed "90% healed", but now, 6 days after the cast was removed, he is still refusing to walk or even stand, and if we try to make him, he screams that it hurts (even though we are supporting most of his weight). He's able to scoot around and climb on the furniture but he's favoring that leg. Should he still be in pain at this point? I'm starting to get very concerned that something is wrong… thank you for your time.

  333. Hello doctor,

    , fracture happened to be at the base of 2nd and 3rd metatarsal (not displaced).. Is it a Lisfranc fracture? am not that much of physically active person.. will i ever be able to walk again in my life?

  334. Hello Dr!

    I fell down, twisted my ankle and the result is a fracture on the 4th metatarsal. It has been 5 weeks now, I went for an X- ray yesterday and the doctor told me healing process has started. He asked me to come back after 2 weeks. Doctor gave me a boot instead of plaster. I am worried if it is slowing the healing process. Can you please tell me if the boot is as good as the plaster?

  335. @Narayanan,

    Base fractures are not Lisfranc, if you are correctly describing your injury.

    Did you take treatment?

    Metacarpal fractures heal well and usually do not cause problems.

  336. @Ashley,

    Generally, by this time, there should be no pain. If there is radiological union as your doctor has suggested, there should not be problem in weight bearing.

    But because he is too young, most likely he remembers the pain that he had when the injury occur.

    Children tend to remember the trauma and refuse to use the limbs.

    However if there is no improvement over one week, you can get him to the doctor again.

    Try comforting him and make him understand that it would not pain. {But confirm first that pain is not there}

  337. @Ann,

    Yes! It could be both ways. But a lesion should not be ignored even if it has come as incidental finding.

    All the best.

  339. Thanks a lot for your reply doctor.

    As per my xray report, it describes that i have fractured the base of 2nd and 3rd metatarsals.. it is exactly 2 weeks now.. Doctor treated me with POP for 10 days and now he has removed the POP and has covered the fractured part with bandages…

    Also doctor, the fractured area has become slightly black, is it common, as it implies the fracture is healing? or is it a cause for worry?..There is no pain in the fractured area, only if i press it there is pain (Manageable).. According to ur professional experience, when will i be able to walk again normally doctor? Appreciate your comments doctor..

  340. @Debbie,

    If you wish, you can get a second opinion. But spiral fracture, that too undisplaced should heal without problems.

    A radiolucent line may persist for longer though.

    Was joint involved initially?

  342. Thank you, Dr. Singh. I did see another hand surgeon for a second opinion. He said progress looks good but will take time. Joint is stiff and swollen due to being immobilized. He adjusted hand therapy to focus on ROM and edema and not strengthening yet. I will see him again in 6 weeks.

  343. Hey Dr. yea my cast is out and he has asked me to gradually start doing things around not to rush in. thank you for your reply

  344. Sir, 5 days ago i got hit by a friends foot during playing.The pain was very less but my friend insisted to go and see a doctor.I then visited a doctor who got my left hand thumb x-rayed and told me that it was a minor fracture and he plastered my hand and told me that he would remove the plaster after 3 weeks but since then i have no pain in my thumb.I wish to remove the plaster but can't decide to do so or not.I even try to move my thumd in the plaster and i absolutely feel no pain please suggest what should i do

  345. Dr. Singh,

    I fractured my fifth metatarsal (right foot) around the beginning of Sept. 2009. It is now into December 2010 (yes, more than 1 year later) and the CT and MRI still show a fracture. In all of the reports, even since November 2009 (last year), the radiologist commented that a healing fracture is suspected.

    There has never been necrosis and the last CT scan (in Nov of this year 2010), still shows a healing fracture. Although, this time the radiologist mentioned that this CT Scan shows much improvement from the original MRI and CT scans from last November (2009).

    I have not been allowed to go to work (I am an elementary teacher) due to policy that will not allow an employee to return to work from being out on medical leave if there are still work related restrictions and accomodations. My doctor says I can return to work, but due to the circumstances of my job (little kids stepping on my feet, constantly having to stand on feet for 8 hours a day — we are not allowed to sit down during class — and the constant walking) he does not feel its in my best interest to return without restrictions.

    Here it is December, and I am still having pain, although not as badly. I asked if surgery would help and was told that surgery is not needed right now because the last CT scan said the fracture is healing.

    I do not technically have a Jones Fracture because the break did not go across the bone, instead it went horizontal. In June, the bone finally showed some union, but as of right now, there is still not complete union.

    I have no health problems other than being hypothyroid and I take Synthroid and Vitamin D3 regularly. I use a bone stimulator, go to PT 3 times a week and have anodyne therapy and cold laser. I also wore a compression boot for 4 months, and now a surgical shoe.

    I have had calcification on the fracture almost since the beginning. My doctor said the only treatment is time, bone stimulator and PT.

    My question is, why do some fifth metatarsal fractures heal within 6-12 weeks and others, like mine, take an undetermined amount of time. Is there anything that can do to speed this healing process for complete healing?

  346. @Narayanan,

    You should avoid walking for initial 2 weeks. You could walk on your heel. It is easier and weight is not distributed on the injured area.

  350. @Narayanan,

    You seem to be doing fine. Most of the patients do extremely well after metatarsal fractures.

    All the best.

  352. @Amitoj Singh,

    If you have a fracture, you should continue with the treatment. I cannot suggest you to remove the plaster.

  353. Thanks Doctor.

    I have 2 more questions, Please answer them as well.

    I got a 4th metatarsal fracture and the 4th toe is numb (most of the time). I noticed that it is okay when I have the foot in the ground, but when I elevate it, it is numb.Now it is the 7th week and is it normal for the toe to be numb?

    Normally how long it takes to walk after the fracture has healed ?

  355. Hi Doctor,

    I broke my 3rd metatarsal 3 weeks back and the fracture happened to be at the base.. I was in POP for 2 weeks and for past 1 week, am in a bandage. And also doctor has advised me to put full bearing using crutches, as it will support healing faster.. When i try to walk with my full weight, fractured area is paining, though not heavily, but it's still paining.. I would like to know ur views whether if walking will actually help the fracture to heal faster?.. also if it pains do i have to stop walking?.. Appreciate your inputs..

  356. Dear Doc,

    Need your very kind advice, Selayang hospital confirmed my 5th metatarsal got simple fracture, its been 5 weeks from the day of fracture but i can still the pain but the bone feels tight now, is this anyhow a sign that bone is still healing?bones guarantee to heal right?im still 29and so worried as I need to start my new work very very soon, your very kind advice is greatly appreciated.. God bless…

  358. @Sathish,

    If it is occasional it should be okay, otherwise plaster tightness should be checked.

    How are you now?

  359. @Maura,

    These are individual variation and what you are going through is called delayed union.

    Why it occurs in a person cannot be answered as there are many factors that affect rate of healing. You can go through this article for more insight on this.
    https://boneandspine.com/fractures-dislocations/fa…

    Unfortunately, there is nothing more that I can add to what you are already doing.

    All the best and do let me know when you return to work.

  360. @daisy,

    What has your doctor told you.

    Simple fractures heal very well. BTW how are you now.

  361. @Anand,

    If it pains you can wait for a week or two before you put weight on that foot.

    How are things now?

  362. Doctor.. I feel close to 80% fine… Doctor has asked me to take anothert X ray coming Saturday (25/12/2010), exactly 34 days after fracture. Doctor has asked me to put on full weight from 3rd week onwards.. The 1st 2 days was hell as i thought my doctor has asked me to put on weight pre-maturely. But day by day, the pain slowly subsided and now i have reached a point that it pains really less..

    And my question to you doctor, still am not able to tune my mind to walk properly.. if am walking slowly with full weight bearing there is no pain..But wen i try to walk properly, it pains a little.. Is it normal or is it a sign that my foot is not ready to walk in a normal manner? Also doctor is be there be any chance will we be able to walk without pain if the fracture is not fully healed? Appreciate your inputs doctor..

  363. Thanks Doctor.

    It has been 8 weeks after the fracture. Now I can walk slowly without crutches. I don't feel any pain and don't have plaster or walking boot.

    But my 4th toe is numb (had 4th metatarsal fracture). It is okay only when the toe is in the ground or if it is touching any object.

    I asked my doctor, he didn't give me a proper answer. Please tell me if it is okay for the toe to be numb as I am able to walk slowly.

  364. Hi,

    I am Shriram from Mumbai, I got a Mid Shaft Humerus Fracture without a radial Nerve damage & without an skin damage on 28.10.2010,which was treated surgericaly by implanting plate with 8 screws, Operation was delayed for a week because of Dengue Fewer which i had from 23.10.2010, now after operation i had slings for 2 weeks & then my hand was left without sling & armrest, my last Xray taken on 18.12.10 shows 70% of Bone Union, while a small gap is seen at one end of the bone but the other side of the bone seems to be Compeletly Union without any gap, My Doctor told be by End Dec 10 bone must be healed compelety as i have full range of motions upto 90% & he also told me that I can Drive My Bike from this new year -1.01.11-as of now i can lift upto 3kgs of weight with doctors permission .. ..

    Now if you have Any Suggestions for me .. for better improvement of my Bone ..Pls suggest & also i want to know "will it be safe for me to start Driving from 1st of jan 2011 or not ? & also What Would be the maximum time in months for my Bone to get the Complete strength & to to be completely strong as it was earlier ..?so that i can join GYM to make Muscles..Pls Suggest at the earliest…& How long it Would take for my bone to be healed & to be normal & strong as it was earlier befor accident. Pls Reply

    WISH ALL OF YOU A VERY VERY HAPPY & POSPEROUS NEW YEAR

    Thank You

    With Regards

    Shriram Nadar

  365. Hi,

    Some more info :-

    I am 21 year old & its a left Humerus Fracture

    i am working in a BPO, From last Two months i am off work , I Spent about 60k for the operation

    now i am leading tough time with regards to finance & health so now from this new year i want to rejoin & i am scared of travelling by TRAIN OR BY BUS ..Thats a Reason I want to start driving from this new year

    because i feel i will be safe in my bike rather than public transport

    pls doctor reply asap

  366. @Anand,

    Its part of normal recovery if it does not worsen. You seem to making fine progress.

    All the best.

  368. @Shriram Nadar,

    If you have a united fracture, driving per se is not the problem.

    But you must also know that the united bone further remodels to take the strength originally it had and this takes around one year.

    So any impact that your normal bone may resist may not be tolerated by the bone that has just united.

    All the best.

  369. @Shriram Nadar,

    I understand your concern. I have already answered your previous question.

    I would advise you take public transport rather than bike.

    Two wheeler riders have higher chances of falling. As your bone is not that strong yet, even a minor fall could cause the harm.

    But driving as such would not cause any harm to your already united bone.

  370. hello Dr.

    my daughter is 6 years old compliang from spiral fracture of the lower part of the shaft of tibia which is spiral fracture not displaced she was 35 days ago but without any sign of calus fotrmation by x-R ,she is asthmatic and she need steroid but not depedent i asked if any relation between asthma and #union and is 4 week is suffecient for removal of the cast or full weight bearing with cast

  371. Doctor, wish u and family a happy and prosperous new year… am in 6th week after suffering from 2nd and 3rd metatarsal fracture… Doctor has asked me to start walking from the 3rd week and when am walking it still pains, though not heavily but still it hurts….. Doctor my question to you is..

    1. Is it normal for the affected area to pain even after the fractured is fully healed?

    2. Still there is swelling where it got fractured.. is it a normal sign or is it a cause to worry.,. will it take time for the swelling to come down?

    Appreciate your comments doctor..

  372. i have big quetion ,if inflammation help in the bone formation or curing of bone crack then how we can use the anti inflamatory drug or anti arthritic drug to reduces the inflamation

  373. Hi,

    Doctor Thanks for the Reply

    I went for doctors visit on 31st

    he told me everything is normal, i can ride bike & i can lift upto 4-5 kg but not more than that,

    he told me every month slowly we increase the weight lifting process as slowly & steadily strength of the bone will increase & within next 3 months it will be much stronger then it was earlier,

    he asked me to visit again on 15/1/11 to Take an Xray to check out the growth..

    if you have any suggestion for me .. then pls reply

    Thank You

    Once Again Happy New Year

  374. Hi,

    Doctor Thanks for Your Reply..

    After 2 months of Injury, Everything seems to be fine Now ..

    if you have any suggestions or advise for me then pls reply ..

    I would Really Appriciate, if you can tell me, What would be the safest & secured time

    frame in months for me to start Driving & to start Body Building ..

    Thank You

  375. on dec 27,2010 i fell down and injured my right arm. X- ray result showed proximal humerus bone is broken. Doctor suggested to leave the hand in sling for 9 days so by force of gravity bone comes in place. On second visit with x-ray reports first he decided to go for surgery ( metal plates + screws) then after a while he said he wants to discuss with a collegue before finalizing for surgery. He said he still wants to wait for another 7 days and on next visit he will decide. Could things go wrong from this point? If he dont decide for surgery he told me after this visit i need to come back after 6 weeks and arm will be in sling. Slowly after that therapy will start. At this point i can feel alignment of bones but only untill arm is at 90 position its perfectly comfortable . If i rest ankle then i feel sudden discomfort. Should i ask the doctor for surgery ( include risk of veain damage) while right now all the rest is finr its just the time n patience n fear what will be the result after 6 weeks is bothering me.

  376. It has been 14 weeks since an angulated tib/fib fracture in my lower right leg. Tibial nail and rodding procedure was performed. I am just now getting out of the walking boot. Xrays reveal that the fib is still not healed as there is significant separation still present. In my opinion – it looks as if i fractured the fib yesterday. The 8 week xray is linked here however the 12 week wasn't all that different.

    [URL Moderated]

    Should the fib be healed by now or show significant progress toward healing after 14 weeks? The fracture site is tender to touch but not significant pain. I am starting to walk around with tenderness and slight limp. The biggest issue other than the fib is ankle pain all around where the two screws are positioned? Is this normal? can they be removed? Is that recommended? Range of motion is returning very well however that pain is at time very debilitating. NSAID medication helps and stretching prior to normal activity is a must.

    Thanks in advance for any insight and suggestions.

  377. @Anand,

    Minor pains are common. Swelling if due to callus would go gradually.

    Happy new year.

  378. @shriram Nadar,

    Please follow your doctor's advice.You are making fine progress.

    Thanks for the wishes. Happy new year to you too.

  379. @ramani falguni,

    Yes! It is agood question and ideally speaking they should not be used. Ideally opoid drugs are better choice.

    But the studies have shown that the effect on fracture haling by these NSAID drugs are not significant.

    Intravenous opoid have their own risks and not many drugs are available for oral use.

    Therefore NSAIDs are used frequently.

  381. Thanks for yor Reply Doctor

    As of Now seems to be fine .. If i have any questions I will get back to you

  383. Hi Doctor… it has been 2 months since my metatarsal fracture of 2nd and 3rd base.. Although pain is not severe, it still pains sometimes when i walk.. Doctor when can i walk normally without any discomfort?.. I know its hard to predict but in your professional experience how long will it take to walk normally after a metatarsal fracture. Appreciate your comments doctor.

  385. @Ms Fehmida,

    These fractures are managed both by conservative management and surgery.

    It depends on fracture pattern and patient demand.

    I need to look at the xray before I can comment further.

  387. Hi Doctor,

    I recently broke my left tibia in a car accident. An IM nail was inserted on the same day with 4 screws. I had a 5 week check up last week and the leg radiograph showed no sign of healing. I am a 19 year old healthy male and was simply wondering how long it would take to visually see any kind of union on an x-ray after surgery?

    Thanking you in advance.

  388. @Matthew,

    Though another view [lateral xray] is needed to confirm this but I do not see any sign of union in tibia too.

    Union in fibula is not that important. Tibia is main bone that carries the function of the leg and its union is main concern.

    Do you have another xray.

  389. @Rahul,

    As you said, it is really hard to predict. It depends on type of fracture and the patient profile.

    Few people get better within 6 weeks while other take few months.

  390. Hi Doctor,

    I have fractured my right foot last year (November 2010), specifically my Right Navicular. I was in a cast until the end of December, but the xrays then shown that my bone has not shown union yet and was advised to stay off for another 2 weeks, which I didn't do, as I had to return home overseas a few days later with 30+kg of luggage. I walked with a cane from then on until now. I went to Singapore for vacation for a week, at which I walked for about 9-10 hours a day. After I got back home I had another x ray which showed barely any improvement from December, could this be because of the excessive walking I did?

    As of now there's still a bruise at the fracture area and I have to shift my weight to the side of my foot to walk, I have heard that unless I immobilize my foot again, it will take months, maybe even years to heal. I'm hoping that's not the case, I have an x ray copy, is there a way to show you (e-mail?) without posting it in the public domain?

    Thanks!

  391. Hi Doc..

    im bryan.. my fibula is fracture during playing football on 19 December 2010 and doctor advise me to put fiber glass. now 8 weeks already the fiberglass still in my leg. actually how long the healing taken?

    tq Doc..

  392. Hi Doctor,

    I have a Jones Fracture in my left foot. I've been in an air-cast for 6 weeks now and saw the Doctor today. His exrays determined that I have primary bone healing and no callus formation as you would see in secondary healing. I'm wondering if it's best to have primary versus secondary healing?

  395. @Li Heng,

    Please send it to contact [at] boneandspine [dot] com. Please include xray after initial injury and the one after removal of cast and the latest xray.

  401. I read on Wikipedia that "osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis". How does this look on xray? I could only read the different densities of the bone based on lucenicies. Thank you.

  402. my brother has been asked to use bone stimulator for faster bone growth of his fermur fracture for a period of 3 months. But i am not able to get any dealers for hire of this bone stimulator machine. so can anybody recommend us from where we can get this urgently.

    thanks

  403. @Serene,

    That seems to describe Brodie's abcess, a kind of osteomyelitis but seen rarely.

    More commonly the osteomyelitis is seen as a sclerotic bone shadow [sequestrum] surrounded by radiolucent line and is considered as hallmark of chronic osteopmyeltis. cavitation is another kind of presentation.

  404. @prabha,

    I am not sure. Did you ask the doctor who prescribed it. If you have got it please let me know the whereabouts.

  405. @prabha,

    I'm using a bone stimulator know…and believe that it really has helped my healing process.

    Smith and Nephew is the company that makes them. My doctor put in a script for it and the rep brought it to my home. They are expensive but most insurances will cover it.

    ps…after I bought it I noticed that people sell them used on ebay. Had I known I would have bought mine that way.

  406. evening doc..

    doctor say usually healing time fibula fracture taken 6-8 weeks.actually hong long i can walk normally after my fibula fracture? is it after 8 weeks from fracture i can walk without crutches.

  407. Hi Doc,

    I had a bone infection after getting injury, doctors removed the inplant from my forarm (ulna) 1 year back to remove the infection. now from last 1 year I am not having infection in my hand.

    I need to know how much chances are there to union my bone after surgery,.

    thanks

    Yogesh

  408. When i feel my ulna bone there is a gap. I have had this for years. I dont have any pain, what could it be?

  409. Hello Dr. Singh,

    I was hit by a car on right foot on the morning of 14th March, 2011. I was wearing leather shoes by that time. After hit byt the car there was ignorable swelling and pain. I used crepe babdage in the night while sleeping. On 15th morning I felt pain while walking and went for an X-Ray in evening.

    In X-Ray report, it has been identified as Avulsion Fracture in Cuboid. But I do not have pain near the cuboid from the first day. However, I had pain near fourth and fifth metatarsals towards proximal joints.

    I consulted to a doctor and he advisedme to use anklet in the socks and go for cold compression for 2/3 a day.. Now I am wearing anklet since !7th march evening and doinf cold compresson.

    Now there is no pain near fourth and fifth metatarsals.

    There is some swelling in my foot but I feel it is because of ANKLET. I do not have any pain in my foot. I am not putting full weight on my right fool.

    Is it possible that there is no pain even having fracture in cuboid. When should I go for another X-Ray?

  410. Hi doctor,

    My name is Gisele ,25 years old and I got into a very bad car accident on Christmas even,I broke my 2 femurs,my right hip and arm.

    Right now,3 months later,my femurs are good ,my arm but my hip is not healing so quickly and I m using the stimulates.should I wait more time to heal naturally or should try another surgery which they take bone from my pelvis to replacement?

    What's my chance to my hip heal without any other surgery?

    Tks doctor

  411. hello sir,

    Sir me qasim.Sir i had a fracture 12month's ago

    which was gun shot wound in femur shaft and

    doctor's have removed 3'in bone piece they implant

    rod in it and in the center of shaft 25percent bone

    piece which is healing doc's says that bone will

    grow but till now i don't seen any bone growth in

    bone loss area please tell me is bone growth is

    possible i m 19 but 6feet hight please tell i shall

    be greatfull to u>thankz

  414. @michelle,

    Get an xray after you see your doctor. It would be of help. You can then send the xray to me.

  415. @Gisele,

    What does your treating doctor say? I have too little info and no images to comment on.

  418. Hello Dr. Singh,

    Thanks for the reply.

    I went for another X-Ray on 23rd March and then consulted to my doctor same day. He said why did I go for secod x-ray. There is no point in going through rays. There is visible fracture.. He has asked me to continue with the anklet for next two weeks and come back after two weeks i.e. (6th April.2011)

    In secon x-ray it is clearly showing Avulsion Fracture in Cuboid. A minor part is separated from Cuboid. The size of separated part seems slightly bigger than a button.

    I do not have pain at all in my foot. However, I have fear so I do not put fulll weight on it and limp while walking.

    I stay at third flooor and everyday I come down once in morning and go up in evening.

    Is there any risk involved? Is anklet is sufficient for its proper treatment?

    Please advise.

    Regards,

    Jitendra

  419. Hi Doctor.

    I had a fall in October 2010 and had an xray done in January 2011, 3 months after the fall which revealed a compression fracture of the L1 Vertebrae. After that my specialist referred me for a CT Scan in February 2011 and according to him lytic lesions were found in the compressed bone which had reached up to 50% of the injured vertebrae. Is there any treatment for this as I am going through immense pain and experiencing numbness in my limbs at times. Its been 5months since the injury and no treatment of the fractured bone has taken place yet.

    My blood test results also showed a few nucleated red blood cells and lymphocytes and leukocytes was noted.

  420. Re my previous question.(gap in ulna bone)

    Do you think it could be anything serious as I am a bit wary of going to the doctors a sI feel I may be wasting his time, due to the fact that I have had this gap for years with no pain?

    Michelle

  421. Hello Doctor

    i had an accident almost 2 and half year ago by car broke right femur with multiple fragment, did an operation with long plate screw fitting but unfortunately operation was not successful due to huge gap between bones, after one year the plate was broked and did operation again fixed with same procedure with grafting, now one and half year gone still iam not bearing weight but this time healing showing possitive, i consult different doctor for opinion in india at present iam in saudi arabia and not taking any medication only doing physiotheraphy at home i need your fruitful advise what should i do for quick recovery and weight bearing. still using walker.

    thanks looking forward your tactful advise.

    hamed

  422. My husband (44 yrs) broke one of the bones in his arm, just above wrist. He has been in a cast now for 5 weeks (had the cast changed at week 3). He is still in a substantial amount of pain and it is affecting his sleep. The clinic has x-rayed it twice and said that everything is healing well. He has explained the pain and discomfort to them and they have dismissed it.

    They have told him that it could be as much as 4 more weeks before the cast is removed. Should he be seeking a second opinion?

  423. hi..dr

    i'm emy.i want to ask about what is factor to improve fracture healing? how about increase the number of bone cell? its one of the factor or not? actually I'm was doing my research about bone fracture healing.

    tq

    p/s: sorry about my english..

  424. @Jitendra,
    Should surfice however personally I prefer plaster slab/cast.

    How are you now?

  425. Hello Dr. Singh,

    Thanks for the reply. I am feeling better now.

    My third meeting with my doctor was on ^th April. He asked me to walk without anklet. He asked me to walk on outer feet, inner feet, heel and on fronf part I was not comfortable with front part. I asked him if I can continue with anklet. He said if I feel more secure, continue as there is not harm.

    I am just taking Cipcal-500 once a day.

    Importan point. He said that as I do not have pain at all..so it is possible that there is no fracture. The extra visible bone part could be additional since my birth. This part is called Cuboid accessory. I am surprised.Dont know if he is saying true.

    On last Saturday and Sunday, I walked too much. I do not have much problem now. Although there is slight itching now which was not on friday and saturday.

    Anyways, I will write again to you in two days..

    Thanks alot.

    Regards,

    Jitendra

  426. @michelle,
    I did not mean that it is serious but the phrase gap in ulna does not provide full picture.

    It is up to you to decide if you want to see a doctor.

    But if you have concerns about what you have, you would need to see a doctor to tell you what it is.

  427. @Debbie,

    If you feel that you have doubts or queries which are not being answered, surely you can.

  429. Hi,

    I have been advised for Stem cell transplantation for my forarm fracture. this fracture happened last year and then bone get infections after implant. To get ride of the infection doctor has removed all the implant (plate) since then its in two pieces.

    Please suggest how successful is stem cell transplanation.

    thanks

  430. Hi sir,

    My husband had a femur fracture ( approximately 3 inches above the knee) 7 months back. He had the surgery and a rod was inserted. The healing was happening at a good pace. Now he has a swelling just above the knee where the nuts of the rod are placed. We consulted his surgeon and we were told that the swelling was due to exra bone growth. He was given medicines for 2 weeks.The doctor also said that he can walk without using the stick. After taking the medicines he's a bit relieved of the pain. He's able to walk and bend his leg. But this pain keeps haunting him. The swelling goes up and down. There is no consistency. Like, there is swelling and pain for 2 days, subsides for 1 or 2 days, and again it shows up again.

    Is this b'coz he's walking without using the stick. Is this extra bone growth normal. Would it subside once the healing is complete. I'm asking so many questions because after 4 months of the fracture he was able to walk and bend his leg considerably. This swelling has litrally slowed down the pace with which he walks now. Please advice.

  431. Doc,

    I am 51years old, last December I broke my right hand at the wrist area damaging the cartilage. The doctor who attended to my hand did a fantastic job, its been like 5months now, the operation was on the 24th December. The cast is off with just a screw left in my hand for good.

    I feel good except it hurts from time to time when i use my hands to work. I am a technical worker, My therapist says i am far better than most of his patient except that my doctor warned me not to use the hand.

    I sometimes push a little hard during work after where it hurts in the night but with some ointment i feel better the next day. My question is, will i suffer later if i go on like this? cause this is the comment i use to get from others saying if i go on like this i will damage my hand in time to come. My doctor asked me to wait for 6 to 8 months before i could use it again, but every morning when i start my day there is improvement to my hands. Please advise if i can go on like this or really have to go real slow? I just use my hands to work lightly, exercising with dumb bells but no real heavy lifting. Thank You.

  432. @Priti Punam Lal,

    Sorry for the delay!

    A lytic lesion indicates a pathological process and it is likely that the process was present before you got injured.

    It needs to be investigated. What does your doctor say?

  433. @Mohammed Hamed Ali,

    There is no tact involved in bone healing. You cannot force the bone healing. All you can do is to provide the best mileu for the fractured fragments to heal in best alignment.

    As I am not aware of what your images are like, I can only provide a general guidance.

    Follow your doctor's advice.

  434. @emy,

    It should be but I think activity is more important. Can the number be increased?

    I am not aware.

  437. Hi Dr I had met with a bike accident and had sustained fracture of proximal left radius and ulna and undergone an open reduction & interna fixation(plate and screws) of the same on 28/01/2011. my arm was in cast for 6weeks after that its free, I have 100% of all range of motion now, and feel absolutely no pain now. Dr can u advice me as to when I 'll be able to lift weight upto 5kg?

  438. @Yogesh Kamra,

    I am not aware of the statstics of success rate. This is a novel procedure and though it seems promising, I am not sure how effective it is.

  439. @Jaya,

    When you say extra bone growth, I am not able to make what it is. Can I see xrays?

  440. Is it normal to have an imflammation one month after a bone fracture in the forearm?

    What should I do?

  441. hey

    I broke my 3rd metatarsal in basic training about week ago i have a cast up to my knee. I was wondering how long would it approximately take for it to heal. It started off with stress fractures then a brake. The doctor told me that it was a hole in the 3rd metatarsal not a full brake as in bones separating. I am on leave at home for 30 days and was wondering if i could also take the cast of soon because i feel no pain i can already walk on the cast and everything. i can move the foot in the cast because swelling has gone done so much. i would appreciate the advice.

  442. Hey doctor '

    I had fracture my fibula n 3 pieces playing softball. Its now 18 days today I'm on a cast now for 2 weeks allready I'm going to get another x ray on Friday hopefully it healed allready i don't feel any pain like i use to bu5 i my ankle when they was putting the cast on it was purple now with the cast my feet gets swollen i don't know what to do to make my bone heal what do you think doc what should i do i take vitamins also

  443. broke my fiblua bone on feb. 28. Was in cast until last Wedesday, Now he told me to put alittle weight on it and move it around, but no special treatment. When I put maybe 10% of my weight on it it hurts at the heel. Please send message.

  445. @veis visvananda,

    Your doctor knows the best about your healing and advice on hand usage.

    I think you should follow his advice.

  446. @Umesh Naik,

    I think you should ask this question to your treating doctor. BTW why 5 kgs?

  447. @Jaaziel Ramos,

    I cannot give advice in regards to your treatment. A week is not sufficient period for removal of cast.

    Please follow your doctor's advice.

  448. @Stephanie,
    You can. I hope by now you are out of the cast. How are things going?

  449. @mike,

    Do as your doctor has advised and you would be able to put the complete weight gradually.

  452. Thanks sir for your reply ..sir is there is any alternate solution for my bone healing i m tired of sitting at home i m always in pain i want to do some job but only because of problem i cant do hard work and some times i feel disheart from my life i don't know what to do sir this incident has taken me years before doctors say that after 1 year we will see what to do may be bone graft sir please reply>>>>i m waiting for your reply..

  453. Hi Doctor,

    Am having an ACL complete tear in my left knee. Now am able to walk with almost no limp. I would like to get suggestion from you, whether i should go for a ACL surgery. Am not going to participate in any level of sports that's going to involve cutting or pivoting. Also i feel i can manage day to day activities with almost minimal pain.

    Based on ur experience, i want to know whether am going to do any damage to my knee, if am not going to opt for reconstruction? I had a partial tear in my right knee about an yr back and that knee almost feels like back to normal.

    Though it's difficult to predict about the future consequences, i want to know your views based on your professional experience. Appreciate your inputs doctor.

  454. @Qasim Javed,

    I think that is right approach. Give your bone sufficient time to heal and wait if it gains its thickness.

    Otherwise bone graft.

    I understand it is painful to wait this way but I do not think any other intervention is justified at this juncture.

  455. @Narayanan,

    If you do not have a symptom or functional limitation, I do not think you require a surgical intervention.

    Physical therapy helps in such cases. Please discuss it with your doctor.

  456. Sir, I am having triple fracture in my lumbar spine. Fracture in L2 and L3 and got dislocation in lower back. Spondyolisis? I am not sure about it. How long will it take to heal, Sir?

  457. @Sin,

    Cannot answer your question until you provide me detailed information.

    As of now there is too little information.

  458. Sir, what are details that I should provide you? I am not sure what kind of details are they.

  459. dear doc,

    14 days ago, there was fracture in my left forearm. the findings are below,

    radius ulna L upper M/3,

    ulnar nerve paresis

    two pieces of both bones

    operation was done like CRIF done with close IM nailing AE cast applied.

    so what time it take to healing?

    but there is pain over baby finger and ring finger like stretch of veins and artery and the skin above this two finger does not feal any touch. the doctor said it is only due to stretch of artery from elbow at the time of accident and it will recovered naturally. but some times it pain hard. i take vitamin B12. so please diagnose it and suggest proper medicine for fast recovery .

  463. Hello sir,

    sir please tell me some best medicine which can heal my bone faster…….

  464. @qasim javed,

    While a good diet rich in calcium and proteins would help you to maintain a natural growth and repair.

    There is no medicine to accelerate the healing.

  465. @paresh khunt,

    I am sorry I cannot make the diagnoses. Probably you do not need one as you already have it.

    Symptoms you describe come from ulnar nerve paresis as you doctor must have explained.

    You should already be on medications. Nerve recovery would take usual time in spite of anything and everything.

  467. I broke my bone(around my wrist) in 2009 and i went skating recently and fell on it and now it is giving me pain it hurts should i just wear a wrist brace?

  468. hi dr singh.

    my 78 yrs old baby sitters' shoulder was dislocated and was also told that she has a fracture in the socket. the ortho doc was able to fix the dislocation so her concern is the fracture. right now shes wearing something to hold her arms. my question is:

    1.how long is the healing process?

    2. can she still carry a 2 yrs old baby (like putting him in the high chair or the toilet bowl) or she needs to avoid doing it because it will damage her shoulder again

    3. what is the long term effect of it?

  469. Dear Doctor:

    I broke my ankle march of this year, got surgery a week later which included 5 screws and a plate. On July 11th the hardware was remove. I spent two weeks in a soft cast and on July 26 received a walking boot. My doc says the holes in my bone should heal in 3-4 weeks. Now i know recovery depends on many factors: rehab, diet, bad/good habits, age, gender etc. My question is do the holes in the bone from the screws usually take that long to heal??

    Thank you,

    Tiffany

  470. @Carlos,

    Better ask the person you bought it from. He/she would help you better.

  472. Hello. I broke my 3rd metatarsal on my right foot in Feb. I went to the emergency room and was given a hard soled orthopedic shoe to wear and was told it would heal in 4-6 weeks because it was not a bad fracture. I told the doctor that I live on the 3rd floor and asked if bearing that much weight and climbing stairs would hinder the healing process but the doctor assured me that I would be fine. He advised me to follow up in 6 weeks.

    I lost my job shortly after breaking my foot and no longer had health insurance. I have not been back to the doctor and 5 months later it still aches. I still cannot walk correctly and there is a slight pain when I walk for long distances.

    Based on what I have written, do you know what could possibly be wrong? Is it just healing slow or will I need surgery? I was very active before but now I have gained weight. I am anxious to resume normal activities.

    Thanks for your help!!

  473. i have broken my tibia and fibiula on 15th june,2011,had gone ORIF operation.now 8 weeks have gone.when can I walk properly without any support?plz help.

  474. Helllo, i fractured my femur bone from running 4 years ago, and the pain comes back every once in a while, especially when exercising. is this a normal thing to happen? if not, what could possibly be the reason for it to always hurt?

  475. @Caroline,

    In immediate period after reduction of dislocation, an absolute rest is warranted. Following that gradual mobilization can be begun.

    If there is an accompanying fracture, the rest needs to be prolonged.

  476. @Tiffany Gaston,

    I am not sure what is meant by healing of holes. The holes would have screws in it. Are there any other holes.?

    An xray would help.

  477. @brit,

    Please see a doctor who can examine and investigate you if required. It could be nothing but we need to rule out the causes of pain.

  478. I fell on July 7th and slammed the inside/top of my right foot against a concrete step. I experienced severe bruising across 3/4 of my foot, both top and soul but pain and swelling only at the sight of injury. Since I could walk without any pain I never got an xray. Long story short I am still experiencing pain at the sight of impact and now have a palpable lump. It is extremely painful to put a shoe on b/c of the pressure on the sight.

    I am considering getting an xray to see if it had been broken but I am wondering if it is a waste of money. If I did break it on July 7th, will the fracture even show up on the xray? Is there anything that can be done to help the pain. If I put a shoe on or bump it or any type of contact to the area it feels like someone is stabbing me with an ice pick.

    Any advice is greatly appreciated!

    Lisa

  479. Hello, I fractured my 5th metatarsal (Jones Fracture) July 13, 2011. it's not been exactly 1 mo and couple days had a cast for 2 weeks after a week I had no more pain. Dr. removed cast after 2 weeks and gave me a boot been on the walking boot for 2 weeks. have none to very minimum pain. is it ok to walk on a boot or should I have it non weight bearing? I see many diff opinons on this. is the 5th metatartsal a weight bearing bone?

    thanks for the advise.

    Brandon..

  480. Hi,

    My mother-in-law fell and broke her arm. She could move her fingers for a few hours

    after the break occurred.

    Straight after the x-ray she could no longer move her fingers on the hand of the damaged arm and has nerve damage.

    Could this have happened during the fall and did not show for a few hours or could it have been moving the arm during the x-ray procedure?

  481. I recently spiral fractured my tibia. I have been in a fiberglass above knee cast for over two weeks now. The break starts from the ankle and stops at the mid point of my tibia. Is there a chance of displacement while I am in the cast, the swelling decreased so my cast is a bit loose and I am worried there might be some displacement in the healing process. I did not get any rods or screws attached to my bone.

    Thanks!

  482. Dr. Singh,

    Thank you so much for explaining and illustrating how a broken bone heals. I had a M2 stress fracture in my right foot in 2007. The first x-ray didn't demonstrate the fracture, but I asked to be reassessed 14 days later after discovering on the internet that a stress fracture may not always show up. A callus had formed by the time of my second x-ray where "minimal flattening of the second metatarsal head consistent with mild avascular necrosis" was noted.

    I had what felt like another stress fracture in the spring of 2009 but my foot wasn't x-rayed until the fall despite my ongoing pain and complaints. This was the finding on the fall 2009 x-ray: "Circumferential solid callus formation and mild cortical thickening is seen along the distal shaft of the second metatarsal. This may be in keeping with an old healed stress injury/fracture in this location. No acute fracture is identified". My family doctor assumed it was the callus from the 2007 stress fracture but that x-ray is at a different hospital and therefore could not be compared. Would a callus normally be visible for 2 years? Based on a physical exam, a podiatrist told me I had managed to break M3 as well along the way, but there is no mention of M3 in the x-ray report, so I'm a bit puzzled.

    Now in August 2011, I had my left foot x-rayed just last week because of a suspected M2 or M3 stress fracture, but the initial x-ray was negative. Since my bone density test didn't show signs of osteopenia/osteoporis and I don't walk very fast or very much because I'm waiting for an arthrodesis of my 1st MTP joint (left foot), I'm wondering why I'm experiencing so much pain and possibly recurrent stress fractures. I do think my slightly awkward walk because of hallux rigidus is putting extra stress on my other metatarsals. Since my surgery date is more than an year and a half away, is there anything I can do to mitigate that? What questions should I be asking my doctors in Canada? I'm 55 and not ready for the pasture yet.

    Thank you for helping people by explaining things so well and by answering questions whenever possible.

  483. Hi doc i had a pilon fracture of the distal right ankle tib/fib broken ORIF medial plating on both fibula is healed my question is when I looked at xray tibia still looked cracked after 2 months of healing my doctor said he used bone graft does bone graft show up on xray film?

  485. yeah, vitamin c deficiency. I just got another random fracture last week in my foot, and that femur is prone to breaking again very easily. I'm only 19 years old, and I'm going through this. :(

  487. Hi,

    I fractured and dislocated my neck. C3 is fractured and C3 and C4 are slightly out of line. I am walking and moving properly which is a relief. My consultant said he will review me next week to decide if he needs to intervene and re-allign the dislocation. What sort of treatment would this involve and how long (roughly) will this take to heal? I am anxious to keep my work informed as best as possible as to how much time I will have to have off.

  488. Hi Dr Arun. I am just curious regarding the fracture healing. As you mentioned in the article, periosteum works as a primary source of precursor cells which develop into chondroblasts and osteoblasts.

    If let said bone graft is used (maybe is osteosimulative, osteoconductive or osteoinductive), does it actually stimulate the periosteum to develop to condroblasts and osteoblasts or bone graft stimulates osteoblasts to be more produced as in a duplicate cells?

  489. Hey doctor…i broke metatarsal in 2008 nd was givin a boot nd some meds nd was told not to walk on it nd me being careless I did well it was giving me pains every now and then but it went away for awhile but noe came back nd hurts to walk on everyday and wanted to see if u had some advice because I dont want to go to thw doctor and pay money when its nothing big…and I been takin meds nd nothing helps even took a week off..if u can please get back with me asap…thank u

  492. Dear Dr Arun Pal Singh,

    Update from your response:

    I did get another xray done and the doctor said that my ligaments are damage. The third metatarsal is healed however he performed a squeeze test and said I may need surgery. He also said that because my injury is 7 months out surgery may not be an option. He scheduled a MRI and said he will look to see if the ligaments are seperated if he can put a screw in. If not then he said I will have to live with the pain. My follow up question is that if surgery is not an option would I be able to do physical therapy or will my ligaments start to feel better over time? I miss running! Of course I will ask these questions to my doctor. Just looking for another opinion so your help is greatly appreciated.

  493. Hi i had a tib/fib break and I had two different cast for two months after having rods installed. The doctor gave me a boot which i have worn about for about three weeks. I feel comfortable walking like nothing ever happened. Can I leave the boot? I can feel the callus and it has hardened.

  494. @Lupe,

    @Lupe,

    Sometimes radiolucent lines are visible for longer time whereas other signs of union are present.
    Depending on the duration of surgery, a novice eye may not be able to appreciate that.

    Some graft are in powder form, they might not be visible on xray.