The body’s ability to repair fractures, or broken bones, is a fascinating process. A bone can snap in half or be split into multiple pieces, and the body can regenerate bone tissue and reorganize cells to return the bone to its previous strength. About 90% of fractures that occur heal without any issue. The other 10% of fractures are “nonunion” or “delayed union.”
When a broken bone fails to heal, it is called a “non-union.” The non-union of a fracture can be a side effect of poor nutrition, low vitamin D, older age, or another condition. A “delayed union” occurs when a fracture takes longer than usual to heal. When non-union fractures happen, orthopedic surgeons use research studies and experience to determine whether or not they should perform surgery on the bone. The good news is both types of fractures can be healed without surgical intervention.
Non-Operative Bone Healing
Let’s take a look at the images below. The first image shows a fracture of the right humerus after a fall off an e-scooter.
Shortly after the fracture occurred, the patient developed a stiff shoulder that slowed the healing process. Intensive physical therapy helped relieve the stiff shoulder and improve mobility. Over a six-month period, the bone was able to heal without surgery.
Understanding Fractures and Bone Healing
Secondary bone healing happens in four different but interconnected stages. Patients, physical therapists, and doctors need to be aware of the healing times and stages of bone repair to:
- Ensure that the bone heals
- Regain proper functioning and use of the fractured area as soon as possible
The four stages of bone healing include:
1. Hematoma. This stage of healing begins immediately after the fracture. During this stage, the bleeding of the bones creates a hematoma or blood clot that later acts as the temporary frame needed for healing.
2. Cartilage Callus Formation. Approximately 5 to 11 days after the fracture, the body sends signals to release different types of healing cells to the fractured area, and a callus begins to form. This process, called chondrogenesis, helps stabilize the pieces of bone.
3. Bony Callus Formation. After 11 to 28 days, the body begins to absorb cartilage cells and calcify. At the same time, blood vessels start to repair themselves, which allows for more blood to flow to healing tissue in the body.
4. Bone Remodeling. This stage is the longest and can last anywhere from 28 days to a year. During this stage, the body absorbs cells that do not help the healing process and lays down more cells to build stronger bones. The bones adapt to the stress and demand placed on them and remodel themselves.
Should I Have Surgery For My Broken Bone?
There are a few things to consider when you’re deciding if surgery to repair a fracture or broken bone is the right course of action. If you have a severe fracture, go straight to the emergency room and skip the urgent care. Urgent care facilities are not equipped for severe fractures.
Some fractures are so severe that surgery is the best and only viable option. Some examples of severe fractures in need of surgery include fractures that cause:
- Gross displace of the bone pieces
- The bone to break into more than two pieces
- Open wounds or breaks in the skin that can increase the risk of infection
In the case in the images below, the patient fell on her elbow and had no choice but to restore the boney alignment surgically.
Often, when you see an orthopedic surgeon, they give you a choice to have surgery or not. This may sound strange, but some fractures do not heal without surgery.
There are two ways surgery can help reduce a fracture. Both methods involve getting the pieces of the bone back to their correct position and then holding them there to allow for healing. The clinician reduces the displaced fractured bones without cutting the skin in one method. This process usually involves manipulating the bones and traction. This technique helps realign broken bones using weights, pulleys, and ropes to apply pressure that pulls dislocated areas back into position gently. Traction helps restore the position of a bone while you wait for further corrective surgery. The second method involves cutting the skin and using plates, screws, and wires to hold the pieces of the bone together. This process is commonly known as Open Reduction Internal Fixation (ORIF).
In the case below, the patient fell down a flight of stairs and displaced his clavicle bone. The patient tried to avoid surgery but ended up with a non-union fracture and had ORIF surgery.
ORIF surgery aims to get immediate stability in the bone to allow for earlier movement and better bone approximation/fixation. This procedure is an excellent option for athletes who need to return to their sport as fast as possible. ORIF surgery is also a good option for patients who don’t mind having a scar.
Other types of surgery for bone fractures include removing parts of the bone that may not heal because of a fracture that broke the bones into more than two pieces. Since the pieces of bone are too small or fragile to get good fixation, surgeons need to remove them.
In the following example, the patient fell and fractured her patella’s inferior polea. Using the method described above, the surgeon removed pieces of broken bone and reattached the patellar ligament to the correctly positioned patella.
How Can A Physical Therapist Help With Fractures?
A physical therapist can help heal fractures by:
- Encouraging Early Movement. Patients with fractured bones need physical therapy to get their bodies working again with or without surgery. Physical therapists know when and how to move the body correctly. If you move the fracture too soon or too much, there is a risk of delayed healing or re-fracturing the area. If the fracture remains immobilized too long, patients can experience weakness and a significant loss of range of motion.
- Strengthening Bones. Bones get stronger based on the demands and stresses placed on them. According to Wolff’s Law, progressive weight-bearing and functional resistance training can load the bone and lay down new cells that can harden and help heal the fracture. Physical therapy, when applied appropriately, can enhance and strengthen a patient’s bones.
- Restoring Functionality To The Fractured Area. The result of advanced and custom physical therapy for fractures is restored functionality. As the bones become more robust and stable, so do the surrounding muscles. Once the bone is without pain and the muscles are strong, the patient is ready for higher speed and contact activities.
Consider Athletic Physical Therapy
When dealing with fractured bones, the patient, their orthopedist, and a physical therapist need to work together to get the best possible result. Our physical therapists know how to work with patients and orthopedists to help rehabilitate fractured bones.
Fractured bones don’t have to continue to impact your life negatively. Our ARC Progression methodology is scientifically-proven to help you recover from physical pain and fractured bones in a short amount of time. Contact us today if you’re ready to heal, get back on your feet, and live an active, thriving life.