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fracture management

How do fractures heal?

Bones consist of both mineral and organic components and are surrounded by a periosteal layer that provides blood supply, an integral component of fracture healing. The mineral components of calcium, phosphate and hydroxyl ions give bone its rigidity and strength and the organic components of type I collagen provide bone with resilience and tensile strength. 


The timeframe in which fractures heal varies greatly on a variety of factors such as fracture location, type, patient age and comorbidities. Nonetheless, all types of fractures can be expected to heal in 3 overlapping stages described below. 

3 stages of bone Healing 

  1. Inflammation: A hematoma (bruise) forms around the fracture site and reabsorption of bone occurs in areas of decreased blood supply. During this time, there is an increase in osteoprogenitor cells which form new bone around the fracture site. This process allows for fracture lines to be visible on plain radiographs and explains why some fractures may not be seen on XRay for several days. 

  2. Reparative: New blood vessels form and promote cartilage formation at the fracture site, followed by callus formation. A callus is new endochondral bone formation around the fracture site that is highly cartilaginous which will later ossify. 

  3. Remodeling: ossification on callus and bone remodeling. 


Hematoma (day 1-5) → fibrocartilage callus formation (day 5-11)  → bony callus formation (day 11-28) → bone remodeling (day 18 - months/years) 

How long will I be immobilized for? 

Immobilization of the fractured bone is crucial during the inflammation and early reparative phases to allow for new blood vessel formation. 

Immobilization times vary significantly based on fracture location, type and patient age and comorbidities and can range from 4-8 weeks or longer.

How can I promote healing of a fracture?
  • Smoking cessation 

  • Control of chronic diseases which may impact healing such as endocrine disease, diabetes, anemia, obesity, malnutrition or chronic steroid usage. 

  • Dietary supplements: 

    • Vitamin C and Zinc serve as anti-inflammatories and antioxidants that aid in collagen formation (important for bone, tendon and muscle healing) 

      • 500mg vitamin C per day is recommended through diet or supplementation

    • Vitamin D plays an important role in bone remineralization, an important aspect of fracture healing 

      • 1000 - 5000 IU of vitamin D per day is recommended

    • Calcium is at increased demand in fracture healing as it is required for fracture callus formation

      • 1200 mg of calcium per day is recommended 

    • Dietary proteins are needed for fracture and wound healing. You should aim to eat 1-1.2 grams of protein per kg of body weight.

      • Example:  200 lb male / 2.2kg = 90.9kg x 1.2 grams of protein = 110 grams of protein 

  • Bone stimulator or bone grafting may be recommended by your provider if fracture healing is delayed

My Approach
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