Everything You Need to Know About Fractures and Fracture Healing

A fracture is another term for a broken bone. When we talk about fractures, we use certain terms to describe where the bone is broken, in what sort of pattern, open or closed and if it is displaced (shifted apart) or angulated. Fractures can be nondisplaced (a crack in the bone), spiral, segmented, or comminuted (multiple pieces). The more energy it takes to break a bone, the more damage to the bone and soft tissues, and therefore the blood supply to the bone.

Fractures are treated in different ways and while some can be treated in a cast, brace, or splint, others require surgery to repair the fracture with plates, screws, nails or pins.

Everyone who experiences a fracture will heal differently. Factors that influence fracture healing in addition to the type and care of the fracture depend upon the person who sustains the fracture. These include age, nutrition, overall health and whether or not you smoke.

How are Fractures Treated?
The goal of fracture treatment is to restore the normal alignment of the bone and anatomy so that the fracture heals in the correct position. This sometimes requires that the fracture be manipulated or “set”. This usually requires some sort of sedation and / or anesthesia and can be done in the office, emergency room or sometimes in the operating room.

Non-surgical methods of treating fractures include:

Cast: Casts are a tried and true method of fracture treatment and may be made of plaster or fiberglass. The purpose of the cast is to maintain fracture position and immobilize the bone to allow the fracture to heal in the correct position. Common fractures treated in a cast include hand, wrist, forearm, lower leg, ankle and foot.

Functional Braces: These braces are usually made of molded plastic that function like a cast for specific relatively stable or healing fractures. These are removable for hygiene.

External Fixation composed of threaded pins drilled into bone above and below a fracture with an external frame. “Ex-fix” is often used for temporary stabilization of open fractures or fractures with soft tissue damage until definitive fracture repair.

Surgical Treatment of Fractures

Open Reduction Internal Fixation (ORIF) involves surgical exposure of the broken bone to directly repair the fracture with plates and screws. This is often used in forearm and upper arm (humerus) fractures as well as for tibia and ankle fractures. The fractured bone is actually screwed back together which allows direct bone to bone healing.

Intramedullary Nailing (or Rodding): A nail is placed in the marrow cavity of the bone and usually fixed with screws above and below the fracture. This is an “indirect” treatment of the fracture where the fracture site is not usually opened surgically. The nail acts as an internal splint to allow fracture alignment and healing. This treatment is commonly used for long bone fractures in the femur and tibia.

How Long Does a Fracture Take to Heal?

Most fractures heal in 6-8 weeks, but this varies tremendously from bone to bone and in each person based on many of the factors discussed above. Hand and wrist fractures often heal in 4-6 weeks whereas a tibia fracture may take 20 weeks or more.

Healing time for fractures are divided into three phases:
1. Inflammatory Phase: starts at the time of injury and lasts 1-2 weeks. Bleeding around the fracture organizes into a fracture hematoma or clot on the bone ends. Damage to the tissues results in cell death which is cleaned up by an inflammatory response. The blood clot organizes into a protein mesh where the bone begins to “knit”.
2. Repair Phase: lasting the next 2-3 weeks where actual tissue repair occurs and new living cells of bone, cartilage and fibrous tissue occur at the fracture site. This leads to the formation of a rubbery tissue called “fracture callus”. Calcium is deposited into the callus and can be seen on x-ray at 2-3 weeks after injury.
3. Remodeling: occurs as the fracture callus is replaced with strong organized bone. Remodeling goes on for months after the fracture is no longer painful and appears to be healed on x-rays.

How can you help or speed fracture healing?
1. Follow your doctor’s orders in terms of activity.
For example, some fractures may require early activity and weight bearing to speed fracture healing. Others need to be immobilized and avoid weight bearing. Muscle use in the injured limb helps blood flow, reduces swelling and speeds exchange of nutrients to damaged tissues. It also helps to reduce stiffness and muscle atrophy (shrinkage).
2. Nutrition: Maintain a well-balanced diet. Protein, Vitamins C, D, and K are all essential for fracture healing. Calcium, Magnesium, Phosphorus and Zinc are all elements needed for bone formation and to accelerate the healing process.
3. Smoking: If you smoke, STOP. This is probably the greatest single thing you can do to help fracture healing. Smoking inhibits fine capillary blood flow that is essential to healing.
4. Avoid high dose Nonsteroidal Anti-Inflammatory medicines such as ibuprofen or naproxen. These medications can inhibit the early phase of fracture healing.

Making an Appointment
Are you ready to return to a life of restored mobility and function? Schedule an appointment today with Dr. Bonatus or any of our orthopedic physicians by vesting us online at https://northazortho.com/request-a-visit/ or calling at 928.226.2900.