Is it normal for a fracture to be visible on my x-ray after 50 days? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
Hussein asked me a really interesting question. He said, “I fractured my tibia and fibula. Is it normal after 50 days the fracture is still visible under x-ray, but I am walking with crutches and putting partial weight bearing without any pain or discomfort?”
So, this is a good question. What Hussein’s trying to figure out here is whether or not, I think at the base of his question is whether or not it is actually healed, if it is still visible on the x-ray. He continues and says that you know my treatment was with a fiberglass cast without any surgery since the bones were not displaced.
Displaced means that they’re not in the right place. So, this is good. So, it sounds like he basically had cracks in both bones, the tibia and the fibula, and they put them in a cast. They didn’t have to do surgery, put it back in play in the right place, and put plate and screws on it. But then he wants to know, you know, is it normal that there’s going to be something still visible on the x-ray at 50 days or not
Very good question. The first thing is my biggest concern is that if there is too much motion at the fracture site, like if the cast was loose or something or you’re walking on it in the cast and moving the bones, then there could be too much motion at the fracture site and the fracture isn’t healing. That would be bad. It would be normal, not good, but it would be normal. It would be bad but normal if your fracture was still visible and you were healing the fracture because that would be not healing the fracture because you’re moving it. That would be predictable.
If the fracture is not healing at all, it would definitely be visible at 50 days. There are a couple of other things that you have to really think about here that could be happening at 50 days, and 50 days is not that long, right? So, if you think about that in terms of number of weeks, talking about six weeks, there’s a lot of misinformation about how long it takes fractures to heal, and you’ll generally hear, oh, it takes about six weeks. Well, there’s a very, very wide range of healing.
At six weeks, for sure, you are going to have a fracture that is visible on an x-ray. So, if I took an x-ray of somebody, no matter what the fracture was, if there was an actual visible crack on the x-ray of the tibia, the fibula, a metatarsal bone, it wouldn’t matter and I took that x-ray and showed it to any doctor and said, do you see anything wrong? They would say this bone was broken.
Maybe they wouldn’t be able to tell if it was really healed and the patient could run or walk or whatever at that point, but they would definitely see that there’s something wrong and that the bone had been fractured and was either healing or not healing or in some stage of healing. That would be 100% normal. I would never expect at 50 days that a bone could fracture, particularly both of them.
By the way, to back up a second, if you get a stress fracture in your leg, it is virtually never a stress fracture of the tibia and the fibula. Most of the time when I see runners with stress fractures, they run on it, they get a stress reaction, and then that stress fracture or stress reaction turns into an actual stress fracture where there’s a crack. When there’s a stress reaction, it is just inflamed and irritated. There’s not a crack yet.
When there gets to be a crack, it is visible and when it is that happens to runners, it virtually never happens where you get the stress fracture in the tibia and the fibula. So, it implies to me based on the story that Hussein has given me that he had trauma, either an automobile accident, a fall, something like trip and fall where there’s a car ran into his leg, motorcycle accident, he fell off a motorcycle or horse or something. I don’t know, some kind of trauma, a sudden impact, a sudden force that cracked the bones.
But again, he says they were in the right position. That is good news. But if there’s a visible crack in both and you broke both of those two bones, it tells me that it is a high impact force, not a low impact force like repetitive microtrauma that you could expect from running and developing a stress fracture.
What we see that evidence is healing is that you get these little wavy lines that we call trabeculation across the fracture and so, where you see like a dark line between the two broken pieces of bone initially, over time that gets obscured, it looks foggy. Then it looks like it has these solid little white lines that go across it and those are little solid pieces of bone, basically little channels that are making the bone more stable and is still visible for a long time.
I have seen people who had stress fractures where they thought that they just got a stress fracture and you look at the x-ray and you go, oh no, that is a stress fracture and based on their story, I have had many doctors when I presented those things at medical conferences and said, can this guy run his race in two days or not? They’re like, no way there’s a stress fracture and that stress fracture was actually a very old fracture, years old. It has been there for a long time. It looks bad just because it is linked to this story of, well, I was just running to catch a bus and my foot started to hurt. I’m worried to have a stress fracture and the doctor looks at it and we go, oh my gosh, it is a stress fracture. You can’t run and it wasn’t a stress fracture. It was an old fracture that healed.
The point here is that even when it is years old, it may still be visible on the x-ray. That is why it is super important that we link the severity of your problem to your whole story and the severity of your injury right now. You’ve got to link all of that stuff together. So, it is not just when it happened, it is how bad it is. It is what you did before the injury, and it is what you do after.
You’ve got to know that on an x-ray, that is an x-ray alone is not sufficient to make your diagnosis or even tell somebody like Hussein 50 days in, if it is healed or not. That is why the radiologist never makes a diagnosis. The radiology report that details the stuff they see in your x-ray, it is always their impression. Meaning this is what I see based on this one little sliver of information about you as an athlete.
If you want to understand the whole strategy I use with runners who have stress fractures and are trying to get back to running, what the biggest mistakes our doctors make, the biggest mistakes runners make, I explain all that stuff in the stress fracture masterclass. You can come join me for free in that training. It is about an hour long. Get it at www.docontherun.com/stressfracturemasterclass. So come sign up and I’ll see you in the training.
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