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Bone Healing
How Does a
Bone Heal?
How Long Does Bone Healing Take?
What Helps Promote Bone Healing?
What Can Hinder Bone Healing?
How Can Slow Healing be Treated?
How Does a Bone Heal?
All broken bones go through the same
healing process. This is true whether a bone has been cut as part of a surgical
procedure or fractured through an injury.
The bone healing process has three overlapping stages: inflammation, bone
production, and bone remodeling.
- Inflammation starts immediately after the bone is fractured and lasts for
several days. When the bone is fractured there is bleeding into the area,
leading to inflammation and clotting of blood at the fracture site. This
provides the initial structural stability and framework for producing new bone.
- Bone production begins when the clotted blood formed by inflammation is
replaced with fibrous tissue and cartilage (known as “soft callus”). As healing
progresses, the soft callus is replaced with hard bone (known as “hard callus”),
which is visible on x-rays several weeks after the fracture.
- Bone remodeling, the final phase of bone healing, goes on for several
months. In remodeling, bone continues to form and becomes compact, returning to
its original shape. In addition, blood circulation in the area improves. Once
adequate bone healing has occurred, weightbearing (such as standing or walking)
encourages bone remodeling.
How Long Does Bone Healing
Take?
Bone healing is a complex process. Speed and success differ
among individuals. The time required for bone healing can be affected by many
factors, including the type of fracture and the patient's age, underlying
medical conditions, and nutritional status.
Bone generally takes 6 to 8 weeks to heal to a significant degree. In general,
children's bones heal faster than those of adults. The foot and ankle surgeon
will determine when the patient is ready to bear weight on the area. This will
depend on the location and severity of the fracture, the type of surgical
procedure performed, and other considerations.
What Helps Promote Bone
Healing?
If a bone will be cut during a planned surgical
procedure, some steps can be taken pre-and post-operatively to help optimize
healing. The surgeon may offer advice on diet and nutritional supplements that
are essential to bone growth. Smoking cessation, and adequate control of blood
sugar levels in diabetics, are important. Smoking and high glucose levels
interfere with bone healing.
For all patients with fractured bones, immobilization is a critical part
of treatment, because any movement of bone fragments slows down the initial
healing process. Depending on the type of fracture or surgical procedure, the
surgeon may use some form of fixation (such as screws, plates, or wires) on the
fractured bone and/or a cast to keep the bone from moving. During the
immobilization period, weightbearing is restricted as instructed by the
surgeon.
Once the bone is adequately healed, physical therapy often plays a key
role in rehabilitation. An exercise program designed for the patient can help in
regaining strength and balance and assist in returning to normal activities.
What Can Hinder Bone
Healing?
A wide variety of factors can slow down the healing
process. These include:
- Movement of the bone fragments; weightbearing too soon
- Smoking, which constricts the blood vessels and decreases circulation
- Medical conditions, such as diabetes, hormone-related problems, or vascular
disease
- Some medications, such as corticosteroids and other immunosuppressants
- Fractures that are severe, complicated, or become infected
- Advanced age
- Poor nutrition or impaired metabolism
How Can Slow Healing be
Treated?
If the bone is not healing as well as expected or fails
to heal, the foot and ankle surgeon can choose from a variety of treatment
options to enhance the growth of bone, such as continued immobilization for a
longer period, bone stimulation, or surgery with bone grafting or useof bone
growth proteins.