Previous blogs have explained the nature of fractures in what we would consider to be the expected course of healing. Unfortunately, fractures do not always heal in the expected way or at all for that matter. Complications can arise that can change the course of treatment over time and some fractures are more susceptible to these complications.
The standard course of healing for fractures takes about 3-4 months. The first stage of healing is inflammatory in nature and is typically the most painful. Patients find the injured area to be swollen, sore, and often bruised. The second phase of bone healing involves soft callus formation over the area of the fracture. Ultimately, that callus remodels into bony tissue that allows the bone to be strong and resilient once again. Several factors can affect this general process such as the location of the fracture, compliance with the treatment plan, and general health.
Sometimes, fractures are declared nonunion because,for whatever reason, the bony callus that normally develops to heal the fracture site does not form. This can be caused by a lack of blood supply to the area. For example, fifth metatarsal fractures in the foot and scaphoid fractures in the wrist happen to be in locations that are not well-vascularized. It is that lack of vascularization that can cause an injury not to heal. Injuries require blood flow to bring the proper nutrients to the area. Setbacks such as infection or additional trauma to the area can also cause a lack of healing to occur. Sometimes bone stimulators are prescribed for patients with a fracture that did not heal. This machine is applied to the fracture area daily and uses electromagnetic waves to stimulate healing in a conservative manner. Sometimes surgical management is recommended in the form of a fixation surgery that uses hardware to stabilize the fractured fragments.
Fractures can also be deemed malunion. This can happen if the affected bone fragments are not sufficiently aligned prior to being immobilized for a period of time. Alternatively, if immobilization is discontinued prematurely, a once-aligned fracture site can fall out of alignment and ultimately be stiff and painful during daily activity.If this occurs, surgical intervention may be recommended by your physician. The procedure often used is called an osteotomy or the cutting and re-aligning of bony to restore function.
Delayed union means that it is taking longer than expected for a fracture to consolidate, or forma bony callus at the site of the injury. Delayed union can occur because of comorbidities such as diabetes or osteoporosis. Smoking, excessive drinking,regular nonsteroidal anti-inflammatory drugs, and nutritional insufficiency can also delay the healing of any injury. Obviously, correcting the underlying issue (cessation of smoking, controlling blood sugars, supplementing additional vitamins, etc.) will likely be beneficial is providing the fracture the best opportunity to heal.Sometimes bone stimulators are used for these slow-healing fractures as well. If after three to six months, the fracture is still not healing, it is deemed nonunion. Again, sometimes surgical fixation is recommended to restore stability to the injured area.
These scenarios are the exception, not the rule to fracture healing. However, if you have a stubborn fracture breaking the mold, we’ll guide you through the process of getting it back to a healthy, sturdy bone once again!
This blog is written by one of our very own-Morgan.She is a certified athletic trainer working as a medical assistant with our providers each and every day in our clinic. She obtained a bachelor's degree in athletic training from Carroll University in Waukesha and a master's degree in Kinesiology from Michigan State University.