Image result for broken boneI have broken many bones over my lifetime and some seem to continue to have pain while others are a thing of the past. I have seen some complaints recently about some sports stars that have a broken bone and the expectation is that they will come back in 6 weeks. The reality – despite them being young and healthy – it may take longer and in some cases, significantly longer.

Most everyone I know, has the fundamental understanding, that a broken bone takes 6 weeks to heal. And this “truth” remains for most injuries but certainly there are factors that can cause some individuals or certain bones to grow slower, if at all. But ideally, most bones will take 6-12 weeks.

First, it is important to know that a broken bone is also called a fracture. There are many different types of fractures.

In the orthopedic community, or the medical expertise about bones and injuries, about 5 to 10 percent of all broken bones go on to a delayed union or non-union.  This means that the broken bone is not healing at the expected rate or have stopped healing entirely.

There are some common reasons for the healing of bones to be less than ideal.

1.)  Age of the patient – the older we get – the slower our body tends to heal.

2.)  Co-morbidity.  This means we might have other diagnosis or medical conditions that can slow our tissues growth, including bones. Such examples would be: autoimmune, Diabetes, cancer, Osteomalacia, and many others.

3.)  Severity of injury.  The bone injury might be worse than initially thought. The expected healing process may be longer than anticipated because the injury might be worse that originally pictured.

4.)  Specific bone involved.  Not all bones are created equal. Some bones – such in hands and feet – might have less blood flow to them. This decreases the rate of recovery. Some bones – because of the type of injury and location simply will not heal on their own. The first attempt is to allow the body to heal – but if this can’t happen – surgery or other options may be necessary.

5.)  Misdiagnosis.  The process isn’t perfect. An X-ray sees 2 dimensional of an area and sometimes it is hard to really appreciate the extent of an injury. Sometimes someone may walk on a sprain that latter turns out to be a fracture.

Image result for non union fracture

 

How does a Bone Heal?

  • The healing process is similar in all bone fractures.
  • Three overlapping stages:  1.) Inflammation  2.)  Bone production  3.)  Bone remodeling

1.)  Inflammation

  • This immediately starts after injury
  • Will last for several days to weeks
  • Typically seen for 1-7 days
  • Bleeding occurs into area – bone and soft tissue  (Hematoma)
  • Clotting of blood occurs at fracture site
  • This provides the initial structure stability and framework for the new bone
  • Bone necrosis happens at edges of the bone

2.)  Bone production

  • Clotted blood is replaced by fibrous tissue
  • Typically seen for 2-3 weeks
  • Soft callus – from cartilage also forms
  • Over time, soft callus is replaced by hard bone – also called Hard callus
  • X-ray will pick up hard callus and observed healing process of the bone

3.)  Bone remodeling

  • Final phase
  • Can go on for several months
  • Typically for 3-4 months
  • Remodeling of bone as it forms, becomes compact, and returns to original shape
  • Blood circulation improves in the area.
  • Weight-baring helps encourage bone remodeling when the right time is seen.

 

Types of Bone Fractures

1.)  Simple Fracture

2.)  Compound Fracture

3.)  Oblique Fracture

4.)  Transverse Fracture

5.)  Spiral Fracture

6.)  Comminuated Fracture

7.)  Linear Fracture

8.)  Greenstick Fracture

9.)   Impacted Fracture

10.)  Complete and Incomplete Fracture

11.)  Compression Fracture

12.)  Avulsion Fracture

13.)  Stress Fracture

14.)  Displaced Fracture

15.)  Non-displaced Fracture

16.)  Fatigue Fracture

17.)  Pathological Fracture

To learn more about the specific fracture link here:  Types of Bone Fractures

Non-Union

This is the term that describes when a bone is unable to heal.  This can happen for several reasons such as infection, lack of appropriate blood supply, and when the patient or the bone itself moves too much.

This can result in a fake joint – also known as pseudo-joint formation. This happens when cartilage forms where bone should have.  If the nonunion continues past 6 months of the injury – a surgical option may be the only way to ensure healing of the bone.

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