Why Does it Take So Long for My Fracture to Heal?

January 31, 2011
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When patients are diagnosed with a fracture, the first question they have after the initial, “Do I have to have surgery” is: How long will it take to heal?  The answer obviously depends on the location and severity of the fracture, but no matter the answer, the patient always expresses shock.  They can’t possible fathom why it is going to take X-number of weeks for their fracture to heal.  I’ll let you in on a little secret – there are a lot of factors that go into bone healing and the number of factors that play a part increases as the compliance of the patient decreases!

This week I hope to help you gain a general understanding of what the body must accomplish in order for bone to heal, in addition to some things you can do that might help along the healing process.  We will evaluate bone healing from the approach that you have suffered a fracture that is not significantly displaced and does not require surgery, but that will require casting and non-weight bearing on the affected leg, with crutches for proper healing.

In school they teach physicians that specific cells called osteoblasts, osteoclasts and osteoid matrix are required for adequate bone healing.  The names of these cells are unimportant but their presence at a fracture site is required for healing, allowing the body to form new and sturdy bone.  In an optimal healing environment (which is what we are assuming), the cells are permitted to cross the fracture site, reaching the other side and filling the defect with new bone.

With that said, those cells move across the fracture site and lead to healing in a series of specific steps: the phases of bone healing.

Phase 1: Inflammatory – in this phase, the area between fracture fragments must fill with blood cells and macrophages (think Pac-Man) that remove broken bone from the area, setting the stage for bone forming cells to invade.  This usually takes place during the first 3 days after fracture has been suffered, assuming immediate medial attention and casting has been achieved.

Phase 2: Reparative – in this phase, the cells that we discussed above will invade the area producing and reforming bone needed to fill in the defect.  They deposit all the necessary components of healthy bone setting the stage for the 3rd phase of bone healing.  This phase lasts to about day 21 post-injury.

Phase 3: Remodeling – in this phase, all those cells and components of healthy bone that were deposited during the reparative phase are left to arrange themselves in the direction of healthy bone, matching that of the surrounding un-fractured bone.  Blood supply is fully restored throughout the area of fracture and the bone will strengthen in response to forces applied to it.  Therefore, sometime late in this phase of bone healing your cast will be removed and you will be permitted to place some weight on the affected leg, allowing the body to detect normal weight-bearing forces, strengthening and remodeling your bone in response to them.  This process can last 6-8 weeks from the time the fracture was suffered and even longer if optimal conditions are not achieved.

When suboptimal conditions are present, where the patient is not immediately immobilized, does not remain non-weight bearing on the affected leg and fails to follow their Podiatrists instructions, these phases become skewed.  What can happen is that motion at the site of initial fracture induces additional phases of bone healing that inevitably elongate the healing process.

So what can you do to help the bone healing process stay on course and prohibit those additional phases from coming into play with a longer healing time than is necessary?

  1. Follow your Podiatrist’s instructions.  Whether that be staying off your foot and using crutches for assistance or elevating your foot as much as possible, follow their instructions.  Contrary to popular belief, we do know what we are talking about and we aren’t giving you any of those instructions for our own health, but rather, for yours!
  2. Stop Smoking.  It has been shown that smoking inhibits the natural course of bone and wound healing.  Even cessation of smoking the day you suffer that fracture has been shown to make a difference.  You don’t want to give your body any reason to slow down the process of healing because you need one more cigarette.
  3. Eat healthy.  Eating healthy affects levels in your blood called pre-albumin and albumin which, when you are consuming proper nutrition those levels reside around their normal values.  Should they drop below normal, indicating poor nutrition, healing of bones and soft tissues becomes inhibited.  Eating a balanced diet also provides your body with the calcium it requires to help build strong and healthy bone.  Calcium is a major component in bone.

Understanding the healing process and following these simple guidelines can ease your fears about a long recovery and your fracture will be healed before you know it!

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