How Fractures Heal
Fracture healing is divided into three stages: the inflammatory stage, the healing stage, and the remodeling stage.
Inflammatory stage
This stage begins as soon as your bone breaks. For the first two weeks after your injury, your body will rush healing cells to the area to begin the process of fracture healing. At the end of this stage, the bone will have started to knit together with fibrous tissue. You will not be able to see evidence of this tissue on your two-week x-ray, but be assured that this “healing” process has begun.
Healing stage
After the inflammatory stage, the healing stage begins. This stage usually lasts six weeks, but may last longer. For high-energy injuries, like a fall from a tall height or a motor vehicle crash, this stage can last 16 weeks. At the beginning of this stage, the body starts to lay down tissue that acts as the bone’s “building blocks.” Later in this stage, the body starts to lay down bone. At the end of this stage, the body has actually bridged the fracture gap with new bone and the bone is considered healed. Although the bone will now be strong enough to support your weight and activity, there is still a long way to go in the injury’s healing process.
Remodeling stage
Once the body has healed the fracture, its work is not done. The body wants to “remodel” the bone to make it strong. You will notice once your fracture has healed that you can still see where the bone was broken on an x-ray image. In the remodeling stage, the body attempts to make the bone look like it looked before it was broken. When children break bones, you cannot see where they were broken within a few years. In adults, however, the process is never complete. During the first year after the injury, the remodeling process is in full gear. This process generates considerable inflammation and causes both swelling and mild pain.
After a traumatic injury, patients often expect that they will be completely better and back to normal within a few weeks. Unfortunately, this is rarely the case — even for simple injuries. Take, for example, a little toe fracture. A little toe fracture does not need a cast and heals with no treatment at all. For six weeks, though, it is too painful to wear constricting shoes, and if you hit the toe while putting on your socks there is severe pain. The foot — and the toe especially — remain swollen. After six weeks, the severe pain goes away, but the toe is still too swollen to fit in shoes. The severe pain is replaced by aches and stiffness that increase with activity, an annoyance that will make you want to limit your walking. The toe will remain swollen for a year, with the pain becoming less and less over time. However, even after a year the toe will occasionally swell and ache with weather changes. You can probably now imagine the healing process for larger bones.
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