A fracture occurs when there is a break in a bone due to trauma. This can be a small crack such as a stress or greenstick fracture or a full break across the width of the bone. When this occurs, structures such as nerves and blood vessels within the bones are affected, along with the surrounding muscles, tendons and ligaments. These all have an impact on bone healing.
The duration of the healing is dependant on a few factors such as:
- Mechanism of injury
- Type of fracture
- Displacement distance of the fracture
- Location of the fracture (movement of the area)
- Type of bone fractured
- Bone alignment or misalignment
- Extent of the injury to surrounding tissue
- Infection
- Health status
- Other comorbidities
- Age
- Smoking
Phase 1: Haematoma
This is the first stage of the healing process, and begins immediately after the fracture occurs. Blood vessels are ruptured at the site which leads to 2 things happening – firstly, cell death in the area due to lack of blood supply and injury to the tissues and secondly, haematoma formation. A haematoma is a balloon like swelling of blood, that is caused by bleeding from ruptured vessels into the area. The haematoma forms a type of demarcation to where the healing processes will occur and begins to clot.
Aim of treatment: Immobilise fracture, control pain and inflammation
Timeframe: Immediately after the fracture to a few hours
Phase 2: Granulation formation (Inflammation)
During this phase pro-inflammatory substances are released into the area to remove the dead and damaged cells, as well as to facilitate the healing process. The haematoma is reabsorbed and the area is prepared for new tissue, cartilage and bone formation. Injured blood vessels slowly start to be rebuilt.
Aim of treatment: Immobilise fracture, control pain and inflammation. Treat underlying muscle spasms.
Timeframe: 24 hours to week 1
Phase 3: Soft Callus Formation
In this stage of healing a soft callus is formed. A callus can be visualized as a scab around the fracture, such as the scab formed when we have a cut on our skin. This is a temporary layer that forms part of healing before the actual bone is able to reform as a more permanent healing process (which will come later). A mesh-like layer of cartilage is formed between the ends of the bones, bridging the gap in the fracture (we call this Union). This process is moderated by the balanced action of osteoblasts (bone forming cells) and osteoclasts (bone resorbing cells). This soft type of bone is called Woven bone and is not as strong as normal bone tissue so it is not ready to be loaded yet.
Aim of treatment: Immobilise area. Reduce muscles spasms and ensure range of motion and strength of surrounding areas is maintained where possible.
Timeframe: 48 hours to week 3
Phase 4: Bony Callus Formation/Consolidation
In this phase of the process, the woven bone tissue that was built in the previous phase begins to osify. The cells that were building blocks are absorbed and replaced with a stronger calcified type of bone. As this process goes on the bone gets stronger and starts to recover to full strength.
Aim of treatment: Regain range of movement in the area. Gentle loading and strengthening as per fracture type, location and stage of healing.
Timeframe: week 2 to 4 months
Phase 5: Remodeling
This is the final stage of bone healing. In this stage the remaining bulges (callus) and cartilage of the bone are resorbed by the osteoclasts. More compact bone is formed until the bone is fully and completely healed back to its initial integrity before the fracture occured.
Aim of treatment: Strengthening of surrounding muscles to return back to previous function, including sport specific rehabilitation.
Timeframe: Week 3 to 2 years.
For optimal results of bone healing it is important to carefully follow the regime prescribed by your medical team, consisting of your orthopaedic surgeon, physiotherapist, biokineticist and dietitician.
From a diet perspective, it is important to ensure you are getting a good, healthy diet with the right nutrients to assist bone healing and recovery. If the building materials aren’t readily available then this will affect the healing process.
Physiotherapy is important in the healing process as it aims to decrease inflammation in the initial stages and ensure that you do not lose function of the other tissues or muscles that may be affected. Different interventions are used at the different stages of healing to ensure you regain range of motion and strength once the fracture has healed to ensure you return to your pre-fracture abilities and activities.
Bone healing is a very unique process that needs the correct care to ensure full healing as well as preventing complications. Feel free to contact us should you have any queries or require further assistance.
