Today on the Doc On Run Podcast we’re talking about the difference in healing time of an “old fracture” vs a “recent fracture.”
A runner and a listener to the podcast recently sent in a question regarding how long it takes to heal an old fracture versus a new fracture.
I’m an active 36-year old woman who loves running and hiking and was just diagnosed with a sesamoid fracture. Unfortunately it may have started last year and progressively got worse. My doctor said my options are: try to heal it, live with it (get orthotics), or consider surgery to have the sesamoid bone removed. She said that surgery should only be an option if the pain was too much to deal with. I opted to try to heal it by going non weight bearing for 6 weeks and we will reassess with a bone scan to check on the healing progress. My question is, is there a difference in healing time of an “old” fracture vs. a recent one? Thank you for considering my question! Vicky
I recently did a podcast specifically about sesamoid stress fracture surgery in runners. It was episode #251. If you have a sesamoid injury you might want to check out that episode as well.
The question whether or not it takes longer for a broken bone to heal if it’s a new fracture, versus an old fracture is certainly a great question.
Some authors have written that there are about six million fractures each year in the United States. Somewhere between 5% and 10% of all of those fractures do not heal as quickly as we would hope and turn into what is called a fracture non-union or a delayed union.
A “fracture non-union” is just what it sounds like. It means the two fractured pieces of bone did not unite. They did not get back together and the fracture just did not heal.
A “delayed union” is a broken bone that isn’t healing as quickly as we would expect.
There are many risk factors for developing problems with healing a broken bone. Smoking, diabetes, excessive alcohol use and increasing age are just some of the risk factors for developing fracture healing problems.
If you think about other reasons you might have problems healing a fractured bone, one of those might be excessive activity.
One of the reasons doctors generally put a cast on a broken arm is to hold it still and let it heal.
If you have a broken bone in your foot, you choose to ignore it, you keep running and you keep beating up the bone in the same way you caused the fracture it probably will not heal.
The second you break a bone, an entire series of healing events begins. The bone bleeds that breaks. The bleeding stimulates clotting factors in your bloodstream to stop the bleeding. The coagulation cascade also sends growth factors and chemical signals to your immune system to start the healing process. All of that is happening during the initial inflammatory phase of healing.
The inflammatory phase of healing only goes on for a few days. After the inflammatory phase, the proliferative phase begins. During the proliferative phase of healing you get collagen forming to connect and stabilize the damaged tissue. The bone repair begins. And provided that all goes well eventually the healing progresses to the remodeling phase where the bone becomes stronger.
It’s fairly common knowledge that when the healing process of broken bone gets disrupted, the healing environment starts to change. The initial increase in blood flow that happens during the inflammatory phase starts to die down.
It takes blood flow to get cells into a damaged tissue and facilitate the healing process. So as the fracture gets older and older, the blood flow gets worse and worse.
To complicate matters further, scar tissue may start to develop between the two broken pieces of bone. The accumulation of collagen scarred tissue can impede healing because it acts like a physical barrier preventing the pieces of bone from reconnecting.
So the real issue to think about is how you can boost your healing strategy right now. How can you make sure that you’re doing everything possible to maximize your chances a preventing a nonunion from developing in your foot.
Then you have to talk about all of these different variables, including your diet, your sleep pattern, the amount of stress you and your foot are encountering on a daily basis and figure out if there are any other options, like a bone stimulator, or anything else that might actually help you get your fracture back on track to healing.
Otherwise, you have to really think about the alternative. Doesn’t really sound like it makes sense to remove a bone just because it’s not healing as quickly as you want?
Regardless of the circumstances, when you are a runner and you have an injury you need to make sure that your treatment plan is individualized, specifically for you, your rate of fracture healing and your goals of getting back to running. Don’t ever forget, and don’t let your doctor forget… your goal is not just to heal the broken bone, or remove the slow-healing bone. Your goal is to get back to running as quickly as possible.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!