How does callus show healing on non-displaced fractures? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you’ve had a fracture and you’ve been looking at all the videos or the podcast episodes from Doc On The Run channels, you may have heard a lot about callus. meaning bone callus. Callus that can actually show up on an X-ray or on an ultrasound or on an MRI that indicates some healing process has been at play to stabilize that fracture.
But today’s episode actually comes from a question from KickinChic06, who asked a question on the Doc On The Run YouTube channel in reference to one of these episodes where I was talking about how callus shows up in terms of healing when you have a fracture or stress fracture or pathologic fracture and you’re a runner.
What you said was, “I do a lot of running and jumping drills. I have four non-displaced fractures on my left foot after a hard fall at taekwondo class three weeks ago.” She says it was metatarsals one, two, three, and four but the third metatarsal is a comminuted fracture and the only one that showed up in the X-ray . So, what that implies is that all three other fractures are really small, minor and non-displaced. She said that the other fractures only showed in the MRI meaning that maybe there was a crack, I don’t know, but she did say that the findings on her MRI showed that all fractures were non-displaced. All tissues were intact, and the bones were in good alignment.
Now, those are important things because obviously the bones in the wrong position, if it’s out of alignment, you need to put it back if you want your foot to be normal after it heals. Her question was “If there was no visible gap in between the bones where the fracture is, will the callus still be visible on the X-ray ? How will the callus show for non-displaced fractures on imaging? Thank you so much for creating this channel and for sharing all your expertise to the world.”
Well, thanks very much for posting your question. This is a great question and there’s a couple of different kinds of callus that I’ve sort of explained in other videos. But in short, this is what you have to know is that when the bone breaks and you get a fracture, you get bleeding in between the pieces of bone. You get a blood clot there. The blood clot starts to develop into a soft callus which doesn’t really show up on X-rays but might show up on an MRI and you can see some of that on ultrasound.
You can actually see this bulge where the fracture is starting to heal where you get this stabilization that happens on the exterior part of the bone that you can sometimes see on ultrasound, and sometimes you can even see it on X-rays where you see a little shadow. Now that’s true if it’s non-displaced too. So, if there’s a crack in the bone, there will be callus formation at some point. And so what you basically see is a little shadow or a halo around where the fracture was on the bone.
For example, if you get a metatarsal stress fracture, you go in to see the podiatrist. They take an X-ray of your foot and she says, “Okay, we got an X-ray of your foot. I don’t see a crack. I think you have a stress fracture. Here’s your boot, wear your boot and come back in four weeks and we’ll take another X-ray.” You come back in four weeks, you take an X-ray and then looking at it side by side, the previous X-ray versus the current X-ray four weeks later, you see this little bulge, sort of a shape a hazy bulge, shadow maybe, around this area in the middle of the metatarsal where you had pain. And the doctor then says, “Look. See? I told you, you had a stress fracture. It just didn’t show up on your first X-ray . But now we see it on the second X-ray a month or so later. What you’re seeing is actually the signs of healing that we call bone callus.”
So, that is how when you have a non-displaced fracture in one of the metatarsals in your foot from running and you get healing taking place, it will start to show up either on ultrasound, on X-ray, on MRI or CT medical imaging.
Hopefully this helps you understand a little bit more about that. If you want more information about metatarsal stress fractures, you should check out the stress fracture masterclass where I go into all kinds of stuff and a deep dive. It’s free, you can get it at docontherun.com/stressfracturemasterclass.
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