Authors

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

Fracture Healing

A broken bone is called a fracture. Fracture healing is based on new bone cells growing across the bone ends. This new bone formation is referred to as "callus".

Stages of bone healing are:

The inflammatory stage (minutes to hours)

• Caused by blood forming around the fractured area (haematoma), the cells here signal the start of the healing process. The area will become inflamed (red, swollen, painful)

The reparative stage (one to two weeks)

• Soft callus (a type of bone) replaces the haematoma that has formed. It helps hold the bone together but is not strong enough for the body part to be used. After 2-6 weeks, the soft callus turns to hard callus, and the limb can start to be used.

The Remodelling stage (six weeks)

• Hard callus is replaced by normal bone. The bone is reshaped to smooth off misshapen areas that have formed during the healing process

Management

Management of fractures is based on:

Fracture characteristics

• Location (different bones heal in different timeframes)

• Degree of displacement or alignment (the body can tolerate changes in the alignment of the bone by 'accommodating')

• Number of pieces (known as comminution)

Patient characteristics

• Age

• Medical conditions - heart or lung disease, immunosuppression, diabetes

• Smoking status (nicotine will slow bone healing as well increase the risk of infection if an operation is performed)

• Function (hand dominance, occupation, hobbies)

These factors are all considered by the Surgeon, so not all patients will necessarily receive the same treatment.

For example:

A 27-year-old builder with a displaced wrist fracture may require realignment as their age and occupation require it. However, an 83-year-old patient with a mildly displaced wrist fracture may not require the same treatment. Having surgery is of greater risk for this patient, and their lifestyle may not require them to have a perfectly aligned joint.

The goal of management is to place the bone in an acceptable alignment and allow the body to do the healing. How this is achieved (splinting, manipulation or surgery) is always balanced against any risk of treatment. Unfortunately, no medication can speed up this process. Similarly, the goal of surgery is to place and hold the bone in an acceptable alignment. Surgery does not necessarily mean this process is any faster.

Dr Sundaraj will tailor your fracture management based on all the necessary information. This may range from observation to immobilisation (with a cast or splint) to surgery. Management is based on the most current evidence, considering how this is best applied to you.