Fracture Healing and Physiotherapy

If you have ever broken a bone you know that it can be both painful and limiting to what you can do until it heals. Depending on the fracture, you may need help with certain daily activities (e.g. dressing, walking, driving), especially in the initial phase of the injury.

You often hear of people breaking a bone or having a fracture. The terms “broken bone” and “fracture” are often used interchangeably. There is no difference.

Fractures commonly occur as the result of falls, sports injuries or car accidents. Small fractures called stress fractures can occur with repeated wear. Stress fractures in the bones of the leg in runners. Older people with osteoporosis can be more prone to fractures, spontaneous or fall-related.

While they are not life-threatening they do require medical attention.

The type of fractures ranges in severity based on the force of impact and resulting injury to surrounding tissues.

Common Signs of Fracture

1. Pain with movement or weight-bearing on the injured bone. Typically a deep intense ache, but depending on the break can be sharp.
2. Swelling
3. Warmth
4. Weakness
5. Numbness
6. Bleeding
7. Bruising, change in colour
8. Bone poking through the skin
9. The bone may not look right, maybe bent at an odd angle

How are Fractures Diagnosed?

If you suspect you have broken a bone you should seek medical attention and visit the ER where they can assess the injured area for mobility and to determine potential injury to the joint or blood vessels.

X-rays are the standard imaging technique used to diagnose fractures, but sometimes a CT scan or MRI may be required.

How are Fractures Treated?

Treatment will depend on the type of fracture, the location and severity.

Initially the fracture will be immobilized to promote optimal bone healing.

Immobilisation helps:

• Promote optimal bone healing
• Keep the bone aligned
• Keep the bone from moving until it is healed
• Manage pain

You may be immobilized in a:

• Splint
• Cast
• Sling
• Combination of the above

And this will depend on the location and severity of the fracture.

Immobilization helps keep the fracture aligned and prevents you from stressing the bone further.

Sometimes the bone needs to be “realigned” and this will need to be reduced. This can be done manually with pain medication or with surgery.

Surgery may require insertion of metal pins, plates, rods, screws or wires. These can often stay in but in some cases are removed at a later date.

Bones heal themselves by laying down new bone through a step by step process

1. Formation of a hematoma at fracture site: this starts within a few hours of injury with swelling and formation of a blood clot. The immune system gets to work cleaning up the local debris or injured tissues. An increase in blood vessels also assists in the healing process.
2. Formation of soft callus: this happens over a few weeks as collagen moves in replacing the blood clot. The soft callus is not as strong as bone, hence the need to protect the area in a cast. Disruption of the soft callus can delay recovery.
3. Formation of hard callus: new bone is formed by osteoblasts, adding minerals to the mix to make the bone strong again. This process can take 6-12 weeks.
4. Remodeling of bone and addition of compact bone: osteoclasts enter the picture here and break down extra bone that was laid down during the healing process so bones can get back to their regular shape. At this stage, returning to normal activities helps with further healing. This process continues up to a year or longer.

How long does it take for fractures to heal?

On average a bony fracture will take 6-8 weeks to heal, with children healing faster than adults. The healing timeline is impacted by the location and severity of fracture as well as age and general health, including factors such as decreased bone density and lifestyle factors such as smoking and alcohol consumption.

Casts may need to be worn for anywhere from 4-8 weeks and sometimes longer. The pain will typically settle before the bone has fully healed, but it is important to protect the area until it heals. Once cleared you are able to start Physiotherapy.

The initial goals of Physiotherapy are to:

• Restore mobility
• Rebuild strength
• Retrain movement patterns
• Re-establish loading
• Regain balance, gait, proprioception (lower extremity fractures)

When can I start Physiotherapy?

When you start physiotherapy after a fracture will vary depending on the location and need for casting and/or surgery. Some lower extremity fractures (femur, knee, ankle) may require longer periods of immobilisation or reduced loading whereas elbow fractures may need to be mobilized early on to prevent excessive joint stiffness which can limit function. Your physiotherapist will work alongside your surgeon or treating doctor.

ConnectTherapy™ and Fractures

At RedoHealth we practice ConnectTherapy, an approach which looks at the driver for pain and dysfunction. With fractures your driver is your site of fracture, so if you break a bone in your foot, your driver is your foot.

For those that are concerned about how their fracture might impact other areas of their body, having an assessment with a physiotherapist will help determine how your fracture may influence the rest of your body.

Your Physiotherapist will be able to prescribe exercises to work on mobility and strength in areas indirectly affected by your fracture. So if you have a history of neck or lower back pain, what can you do to manage that while you are moving or walking differently as a result of your fracture.

References:

https://choose.physio/your-lifestage/ageing-well/fractures

https://www.orthobullets.com/basic-science/9009/fracture-healing

https://orthoinfo.aaos.org/en/recovery/fracture-healing-video/