Fractures and Healing

Fractures

This picture is both fascinating and horrifying.  It’s like a car accident or train wreck…you just can’t not look.  What I find interesting is to note that the bones most common in these pictures are the stick bones.  There are four pictures of the lower arms and two of the lower leg.  I just want to point out a few.  This epiphyseal fracture is bad.  If the epiphyseal plateA growth plate in developing bones made of cartilage. is open, there is a possibility. As it heals, the other limb may continue to grow. Now, you have two unequal limbs.  If it’s the lower legs, the imbalance leads to a world of spinal problems.  Physical therapy is really important after an epiphyseal fracture on kids.  Compression fractures, otherwise, are more common with adults, especially those who work in nursing, education, and retail. We are on our feet all the time.  I have many compression fractures, most in the lumbar area.  That is because, in the words of my neurosurgeon, “You have the spineProminent ridge on the posterior scapula dividing it into supraspinous and infraspinous fossae. of a 94 year old woman.” I’m 50 now, so I guess I have the spine of a 100-year old woman.  Ha! I crack me up.  If you are on your fee all day you better get used to wearing your compression stockings and back brace!  Not kidding.  The last one I wanted to point out is just because it horrifies me.  The Pott’s fracture.  This here is the tibiaShinbone; large, weight-bearing medial bone of the lower leg. and the fibulaSlender lateral leg bone; stabilizes ankle but bears little weight. and they have become completely disconnected from the foot.  Like, the foot is kinda hanging off the bottom of the leg like it’s not attached.  And, that’s because it isn’t.  I knew a chef how got one of these.  It could have ruined his career because the recovery was long and difficult.  It was 2 years before he could stand and cook for a full day.  That’s just a reminder that the process of replacing bone take a long time.  It’s now a decade later, so I guess he’s good!

Stages of Healing

So, we have seen ossification, the original building of our bones. We’ve also seen remodeling, which is the continual replacement of our bones. But, what happens when you outright break a bone?  Well, something happens that mushes together ossification and remodeling.  If you fracture a bone, the first thing that happens is like a blood band aid.  No, seriously, the bone builds a blood clot in the broken area.  This is what causes the pain and swelling that are characteristic of inflammation.  This blood clot allows immune cellsThe basic structural and functional units of life. to quarantine the area (just in case).  At the same time, osteoclasts roam the area. They get rid of any bone fragments that are hanging out. Days to weeks after the break, the blood clots beings to break down as it is no longer necessary.  The blood clot is like what the EMTs do for you.  Now we’re at the hospital and don’t need the EMTs anymore.  What starts to form is called callus.  This callus is basically a big bump on the bone.  The callus has two sections. These sections are named according to their location. One refers to tissues inside the bone. The other refers to tissues between the bone and the periosteum.  Inside the bone in the internal callus, spongy boneA porous bone tissue found inside bones, providing lightweight support. is starting to be deposited. It begins along the edges of the blood clot and works inward.  Between the bone and the periosteum, the external callus is made of cartilageA flexible connective tissue found in joints, the ear, nose, and rib cage. Cartilage can be of three. This cartilage also serves as a band-aid. It is similar to that blood clot.  However, the cartilage callus will remain for weeks to months. During this time, the spongy bone is replaced with compact boneDense, strong bone tissue forming the outer layer of bones.. This occurs in both the internal and external areas of the callus.  So, I guess that the callus is kinda like a cast in that it is longer lasting.  However, the cartilage callus indicates that bone is being deposited, blood vessels are being reconnected, and osteonsThe structural unit of compact bone, consisting of concentric lamellae around a central canal. are being reorganized.  Over time, months, the cartilage callus will break down as the internal callus continues to replace the osteons.  But, referring back to the rates of remodeling, the spongy bone of this area won’t be fully healed for 3-5 years. Complete healing of the spongy bone takes 3-5 years. It might not be free of damage for 10 years, until the compact bone is also remodeled.