Fractures can take time to heal
Over the past few months, I’ve had three friends over the age of 60 who suffered bone fractures. Two suffered ankle fractures and the other fractured her humerus (upper arm bone). Healing for all of them took about six weeks.
When a bone fractures, it is the same as if it had broken, said Jonathan Sunkin, MD, an orthopedic surgeon with Falmouth Orthopedic Center.
“A fracture heals in stages that are relatively complicated, and most take about six weeks to heal before they are stable,” he said. “They will continue to heal for about a year and a half or so as the bone remodels/reshapes.”
Stages of Healing
The following stages of healing occur with a fractured bone, according to Dr. Sunkin:
- Hematoma formation: The first thing that happens is the inside of the bone and periosteum (lining of the bone) bleed and form a clot called a hematoma. This serves as a base for healing. This stage lasts a few days.
- Soft callus formation: The hematoma becomes a soft callus, a cartilaginous substance that expands and bridges the two fractured ends and becomes a hard callus. This provides stability and will eventually bridge the fracture gap.
- Hard callus formation: The callus initially looks like a bulbous knot at the fracture site and begins the remodeling process called bone modeling.
- Remodeling phase: This is the final stage of bone healing when reshaping the bone occurs.
Two ways that fractures can be supported externally while healing are with a boot or a cast.
“With a fractured ankle, we can use a boot, which patients like better because they can remove it to shower and bathe,” said Dr. Sunkin. “It potentially helps them put weight on it to help strengthen the muscles that get injured with a fracture and allows them some movement in the foot, so the joint doesn’t stiffen. When I use a cast, I can shape the bones while applying pressure to the cast as it sets. I will sometimes use X-rays to align the bones while molding the cast. The downside is the patient can’t allow the cast to get wet.”
Surgical Treatment
Sometimes surgery needs to be done to better support a fracture.
“With some fractures, we need to operate and put in a screw or a plate and screws to fixate the bone in place,” said Dr. Sunkin. “The most important aspect of the surgery is to restore the length, alignment and rotation which are the tenets of fracture care.”
Surgical intervention allows for primary bone healing with the two ends of the bone in direct contact with one another and a minimal gap between the fractured ends, and there is no callus formation at the end of the bone, he said. The healing that takes place using a boot or cast is called secondary bone healing because the steps in the healing process include a callus formation.
“The most common fractures we see in those over the age of 60 are vertebral fractures, and wrist, hip and pelvis fractures,” said Dr. Sunkin. “We also see a lot of women over 60 who are susceptible to fragility fractures which can be related to osteoporosis, or tend to be low-energy injuries (those caused by a fall a slip, trip or a fall from standing position). Children most commonly have wrist or arm fractures.”
Maintaining a healthy diet is important for preventing bone fractures, he said. Women over the age of 60 should supplement with Vitamin D and calcium, he added.
“If you do have a fall or an injury and the pain worsens over a few days, you should be seen by a physician and have an X-ray. Fortunately, most people do very well recovering from a fracture.”
