A broken bone is a particularly painful experience to go through, and tends to stay vividly in your memory for years to come after the event. Worse than the pain can be the psychological effects of having had part of your body fail – regaining confidence in the injured limb takes time and perseverance, and can be more limiting than the short term effects of the break.
People often ask whether they have broken the bone or merely fractured it. In medical language, a fracture is the same thing as a broken bone. People often interpret a fracture as being an incomplete injury, and a truly ‘broken’ bone being one where the ends have displaced. If you have been told you have fractured your arm or leg, rest assured, it is a broken bone, and the recovery is the same. The severity of the injury will dictate the exact treatment required, and some of the medical terms used to describe the injury patterns are as follows:
- Greenstick fracture = a fracture of the bone where the bone splits on one side, and buckles on the opposite side (the same way a green tree branch breaks)
- Buckle fracture = a fracture where the bone surfaces do not separate, but merely crush or deform. The easiest way to think of it is what happens to a Coke can when you crush it – the edges are intact but the structure is disrupted and bends.
- Comminuted fracture = the bone has broken into many pieces at the site of fracture. An easy way to think of it is that there is now a ‘community’ of bone pieces.
- Open or compound fracture = this is where the fractured bone has come out through the skin, or something has pierced the skin and caused a fracture.
Fracture healing begins the minute you break the bone. Bones bleed quite a lot, and the bone is heal together by the blood clot that forms. This has the consistency of jelly, and so will not be strong enough to support the bones unless something else is done to assist it – hence the use of plasters and surgical implants. Nothing your surgeon does can make the bones heal any quicker – the casts and metal implants are functioning to create a stable environment for your body to heal the defect in the appropriate position for return of function. This clot will be replaced with scar tissue, and your body will convert that to cartilage and then mineralised bone. Once the bone has reformed to the point it can withstand loading, you will be allowed to use it. If you attempt to use the area before the process has completed, you run the risk of re-breaking at the site or having the bone heal in the wrong position.
How long will my fracture take to heal?
Unfortunately there is no constant answer to this question, but the rough guide is that a simple small bone fracture will take 6 weeks to heal to the point of daily use. A larger long bone fracture, such as the tibia (shin) or femur (thigh) will take 12 weeks. Some bones can take longer than this, and there are many factors that can alter these numbers.
What can slow my fracture healing?
There are numerous causes of a delayed union of a fracture, with the most common being:
- smokers = the decreased oxygen in the blood severely inhibits the ability of your body to heal damage. Cutting back or stopping smoking will help your body to heal.
- diabetics = those with poor sugar control have slower rates of bony union.
- infection at the site = infection will cause extra tissue damage at the site and delay the stages of bone healing.
- high energy injuries with comminuted fractures = simply put, the worse the injury, the longer it will take to heal.
What can I do to help my bones heal?
The first step is to closely follow the plans and restrictions that you have been given by your doctor and physiotherapist – we know the loss of mobility and independence that comes with many breaks and their treatment is frustrating, but the treatment plan is designed to help. If you fail to follow the restrictions, you may have a poor outcome or end up needing further treatment.
Many people ask about diet and supplements, and the simple answer is that if you have a balanced diet normally, you do not need to worry about supplementing it to heal your fracture. If you have any concerns, supplementation with calcium tablets, 20 minutes of sun exposure daily or vitamin D tablets, and a good multi-vitamin will not cause any harm. From the diet perspective, your body will rebuild the damaged area using protein and numerous trace elements, but the main components being calcium and phosphate. A diet that includes meat, dairy, fruit and vegetables will provide all that you require.
After 6 weeks can I return to sport or work?
The answer to this is usually no, though with some exceptions. By six weeks, the bones have healed to the point that they will withstand the load placed on them by normal daily tasks. As you put load on a bone, it reacts by becoming stronger, in the same way that muscles get bigger the more you use them. It is recommended as a rough guide that however long you received treatment for the fracture, the same length of time should be taken off sporting activities. For most cases, this means that you have 6 weeks in a cast, and then 6 weeks gradually returning to full activity before you play sports – a total of 3 months. Obviously this will be longer with more severe injuries and larger bone involvement. Work is a different matter and common sense needs to be applied. If you are in a sedentary job, you can often return whilst still in a plaster. If you are heavy manual labour, you may need to treat it like returning to sport, and wait the full recovery period.
Will I be able fully functional when I come out of the plaster?
This is a similar question to the one above, and what needs to be taken into account is the impact the broken bone has on the whole body. When you injure a limb, your brain is smart enough to stop you from using it. After only a few days of inactivity, you begin to lose muscle mass in the limb. After 6-12 weeks of inactivity, the limb is substantially weaker than it was, and often your overall level of fitness and strength has also declined. Though you may be at the stage where your fracture bone will let you return to sport and work, the fact that you are physically weaker means that you are prone to re-injury of the area, or indeed injury to other parts that are now weak. Your brain will recall how to play and work, and you may try to do things that you could do before the injury, but with the muscle weakness and decreased bone and joint strength, you are more likely to injure yourself. It is essential that you go through the appropriate rehabilitation before attempting to return to strenuous physical activity. Your physiotherapist is essential in this respect – it is well worth the time and cost to have a professional design and monitor your rehab, otherwise you may be spending more time with doctors and more time off work with repeat or new injuries.