Why Does Some Broken Bones Take Longer To Heal?

Image result for broken boneWhat happens if your broken bone takes longer to heal than you are expecting?

I have broken many Bones over my lifetime and the time it took to heal each bone depended on the severity of injury, location, and other factors.

Typically, a broken bone can take anywhere from 4-16 weeks to heal, with the typical understanding that most bones should take 6 weeks to heal.

But several things such as: age, severity of injury, other medical problems, location of injury and much more can drastically affect the healing process.

It is important to understand that a broken bone is also called a bone fracture. There are many different structural 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. Some fractures involve Joints which may be a more severe injury and prevent healing.

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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