Introduction
Like any other injured tissues in the body, an injured (fractured bone) can heal. Bone is unique as it can regenerate itself and forms new bone during the healing process.
What are the steps in bone healing?
There are 4 basic steps that are overlapping with each other when fractures heal :
- blood clot formation and inflammation – within minutes to 72 hours of a fracture
- soft bridging bone – within 2 days to two weeks
- hard bridging bone – within two weeks to six weeks
- union – within three to six months
remodeling (to get back normal shape) – may take years
What is required for good bone healing?
In general, healing can only occur if there are :
- adequate blood supply
- good bone to bone contact
- good stability of the fracture site
Factors influencing good fracture healing :
|
General
|
Local
|
|---|---|
| Young | Simple fractures |
| No medical problems ie diabetes | Less or no bone loss |
| Active | Good blood supply |
| Good nerve function | Cancellous/soft bones ie near joints |
| Good nutrition | Adequate immobilisation |
| Not a smoker | No presence of infection |
| Early weight bearing |
What can cause problems in bone healing?
|
General
|
Local
|
|---|---|
| Old age | Shattered fractures |
| Medical problems | Tissue between the fracture ends |
| Inactivity | Poor blood supply |
| Poor nerve function | Diseased bones |
| Malnutrition | Moving too early |
| Drugs (Steroids) | Infection |
| Smoking | Late weight bearing |
How do doctors assist in fracture healing?
Fractures can be treated either with or without operation. Only doctors trained in orthopaedics or related fields can determine this. The main aim is to correctly straighten the fractured bones either using a cast (POP) or using surgery by inserting metal rods or plates.
What complications are associated with fracture healing?
Problems can be broadly divided into :
- malunion (fractures heal in wrong position)
- delayed union (fractures that heal later than usual)
- nonunion (fractures that do not heal)
Why do complications occur?
When patients do not seek modern medical treatment or seek treatment at a late stage, the fracture may heal in the wrong position. Traditional treatment is not advisable as this is associated with a lot of problems which may be difficult to treat later and can also be very dangerous.
References
Campbell Operative Orthopaedics Orthoteers Syllabus
| Last reviewed | : | 26 April 2012 |
| Writer | : | Dr. Izan Ibrahim |
| Reviewer | : | Dr. Heselynn Hussein |
