© Cambridge Fracture Clinic - Mr Lee Van Rensburg - Cambridge; United Kingdom
Cambridge Fracture Clinic

Bone healing

General

 Bone heals generally in two ways 1. Primary bone healing 2. Secondary bone healing Most fractures heal by secondary bone healing.

Secondary bone healing

Secondary bone healing is the process where the body throws out fibrous or scar tissue in response to the injury and movement between the bone ends. As time goes by the fibrous tissue accumulates and matures, making the bone ends stiffer and reducing the movement. With the stimulation of a little movement the scar tissue is then converted to bone. This bone that forms around the fracture is called callus. You may notice it as a hard swelling under the skin where the break is. With more time as the callus/ new bone matures and the construct gets stiffer the bone bonds bridge across the fracture site and "union occurs". In this process a little movement is good, too much movement is bad. Doing nothing is just as bad as doing too much. It often means listening to the fracture, not figuratively but listening to it: "If it hurts you are doing too much if not you can do a little more."

Primary bone healing

Primary bone healing, this form of bone healing only occurs in situations where there is no movement between the bone ends and they are held compressed close together. It usually occurs only if an operation has been done and the fracture ends fixed rigidly with plates and screws. The bone we have today is not the same as the bone we had 2 years ago. Bone is continually remodelled in a process where bone is taken away and laid down again. Special cells called osteoclasts are continually tunnelling through your bone taking away bone, osteoblasts follow the osteoclasts and in response to the stress on the bone they lay down as much new bone as the body needs. This remodelling process continually repairs micro cracks in the hard bone. Movement or a gap at the fracture site is not desirable here as the cells can only bridge across a small gap. Hence when primary bone healing is selected as the best method of repair the bone ends are often fixed rigidly with plates and screws.

Enhancing bone healing

We live in a world of microwaves and emails, the world travels very fast and when we have broken something and are told it may take 6 - 12 weeks to heal then it would be nice to have something speed up the healing process. There are several experimental ways of speeding up the healing process, as with all things in orthopaedics it is about weighing up the pro's and con's of any treatment. Practically day to day their is very little that can be done except listening to your instructions on how much you should or should not use the injured limb. Stop smoking Smoking slows down bone healing significantly, debate continues on the use of nicotine replacement, but on balance it is better to use nicotine replacement than to continue smoking. NSAID's (Non steroidal anti-inflammatories) These are the best pain killers for bone pain and as such we prescribe them when you have a fracture. They do however slow down bone healing. Don't use them thinking they are speeding up the healing process and avoid them if you can control your pain  in other ways, eg. rest and elevation (see pain killers). Potions and lotions There are no real potions or lotions that have been scientifically proven to enhance bone healing. If you are well nourished and have a normal diet, no dietary supplements will help the healing process. "You can eat as much goats cheese, drink as much milk as you like it will make no difference to the healing process.” Calcium supplementation is sometimes prescribed if you have osteoporosis not to speed up the healing process but to strengthen your bones to prevent further fractures. Magnets, ultrasound, electricity and laser treatments Bone healing is affected by magnetic fields and electric currents and several methods are being tried to enhance bone healing with these mechanical methods, the studies are small and although some companies offer you your money back if it does not heal. They are banking on the fact that nature on her own will heal the majority of fractures. Growth factors There are several growth factors available and artificial bone substances that can speed up the healing process. Bone morphogenic protein (BMP), Platelet rich plasma (PRP), Demineralized bone matrix (DBX), bone marrow injections, artificial bone substances. To introduce these substances it means injecting them into the fracture site or cutting the skin and placing them at the fracture site. These are presently reserved for complex fractures, they are not quite experimental but similarly not mainstream treatment for fractures yet. Surgery Surgery can speed up the healing process to a degree by bringing the fracture fragments close together. We still rely on mother nature to ultimately heal the bone. Surgery with internal or external fixation may stabilise the bones enough that although the bones are not healed the construct is strong enough to allow earlier return to function and optimal recovery. HOWEVER an surgery carries potential risks and complications.
Fresh  Fracture 6 Weeks 6 Months
© Advanced Nerve Blocks

Bone healing

General

 Bone heals generally in two ways 1. Primary bone healing 2. Secondary bone healing Most fractures heal by secondary bone healing.

Secondary bone healing

Secondary bone healing is the process where the body throws out fibrous or scar tissue in response to the injury and movement between the bone ends. As time goes by the fibrous tissue accumulates and matures, making the bone ends stiffer and reducing the movement. With the stimulation of a little movement the scar tissue is then converted to bone. This bone that forms around the fracture is called callus. You may notice it as a hard swelling under the skin where the break is. With more time as the callus/ new bone matures and the construct gets stiffer the bone bonds bridge across the fracture site and "union occurs". In this process a little movement is good, too much movement is bad. Doing nothing is just as bad as doing too much. It often means listening to the fracture, not figuratively but listening to it: "If it hurts you are doing too much if not you can do a little more."

Primary bone healing

Primary bone healing, this form of bone healing only occurs in situations where there is no movement between the bone ends and they are held compressed close together. It usually occurs only if an operation has been done and the fracture ends fixed rigidly with plates and screws. The bone we have today is not the same as the bone we had 2 years ago. Bone is continually remodelled in a process where bone is taken away and laid down again. Special cells called osteoclasts are continually tunnelling through your bone taking away bone, osteoblasts follow the osteoclasts and in response to the stress on the bone they lay down as much new bone as the body needs. This remodelling process continually repairs micro cracks in the hard bone. Movement or a gap at the fracture site is not desirable here as the cells can only bridge across a small gap. Hence when primary bone healing is selected as the best method of repair the bone ends are often fixed rigidly with plates and screws.

Enhancing bone healing

We live in a world of microwaves and emails, the world travels very fast and when we have broken something and are told it may take 6 - 12 weeks to heal then it would be nice to have something speed up the healing process. There are several experimental ways of speeding up the healing process, as with all things in orthopaedics it is about weighing up the pro's and con's of any treatment. Practically day to day their is very little that can be done except listening to your instructions on how much you should or should not use the injured limb. Stop smoking Smoking slows down bone healing significantly, debate continues on the use of nicotine replacement, but on balance it is better to use nicotine replacement than to continue smoking. NSAID's (Non steroidal anti-inflammatories) These are the best pain killers for bone pain and as such we prescribe them when you have a fracture. They do however slow down bone healing. Don't use them thinking they are speeding up the healing process and avoid them if you can control your pain  in other ways, eg. rest and elevation (see pain killers). Potions and lotions There are no real potions or lotions that have been scientifically proven to enhance bone healing. If you are well nourished and have a normal diet, no dietary supplements will help the healing process. "You can eat as much goats cheese, drink as much milk as you like it will make no difference to the healing process.” Calcium supplementation is sometimes prescribed if you have osteoporosis not to speed up the healing process but to strengthen your bones to prevent further fractures. Magnets, ultrasound, electricity and laser treatments Bone healing is affected by magnetic fields and electric currents and several methods are being tried to enhance bone healing with these mechanical methods, the studies are small and although some companies offer you your money back if it does not heal. They are banking on the fact that nature on her own will heal the majority of fractures. Growth factors There are several growth factors available and artificial bone substances that can speed up the healing process. Bone morphogenic protein (BMP), Platelet rich plasma (PRP), Demineralized bone matrix (DBX), bone marrow injections, artificial bone substances. To introduce these substances it means injecting them into the fracture site or cutting the skin and placing them at the fracture site. These are presently reserved for complex fractures, they are not quite experimental but similarly not mainstream treatment for fractures yet. Surgery Surgery can speed up the healing process to a degree by bringing the fracture fragments close together. We still rely on mother nature to ultimately heal the bone. Surgery with internal or external fixation may stabilise the bones enough that although the bones are not healed the construct is strong enough to allow earlier return to function and optimal recovery. HOWEVER an surgery carries potential risks and complications.
Cambridge Fracture Clinic