Dr. Timothy Young, a Board Certified Foot Surgeon, Discusses How to Tell if a Fracture is Healing

Dr. Timothy Young, a Board Certified Foot Surgeon, Discusses How to Tell if a Fracture is Healing

Dr. Timothy Young, a board certified foot furgeon, discusses how to tell if a fracture is healing.  Also, when does your Doctor know when the bone has healed enough to get out of that boot or cast?
 
Bone healing occurs after a fracture or bone, or fusion.  In each case it is important to protect the bone and modify weightbearing or gait to allow the bones to heal in the appropriate alignment and position.  For example, if you have a fracture of your second, third or fourth metatarsal you don't want to put regular unprotected weight on it because the far end of the bone or distal aspect will tend to elevate and then heal out of alignment, causing a long-term problem with the structure of your foot.  Another exam would be after Lapidus or lapiplasty bunion surgery that requires a fusion of the joint.  Again, bone healing is critical and needs to evaluated during the postoperative course.
 
X-rays are one aspect of evaluation.  Your doctor will look at your x-rays and determine if there is signs of appropriate bone bridging.  One bone heals without excessive motion there is no bone callus and this is called primary bone healing.  This can be difficult to diagnose.  X-rays may show only incremental healing and filling at the fusion site or fracture site.  Initially this is quite subtle.  At times ultrasound imaging can be quite helpful and can show areas of bone bridging and areas that do not have any bridging.  CT scan can be useful.  
 
Timing is another key.  For younger patients for example those that are less than 20 years old one would expect bone healing to as fast as 4–6 weeks, for definitive stable bridging to be seen on x-rays.  But as we all age bone healing can take longer.  So for middle-aged patient it could take 8 weeks.  And as we get older for example passed 50 or 60 years old it can take 8–10 weeks.  Bone density and overall health can also be a factor, as well as other concerns such as smoking.  I'm not surprised for an older patient that I don't see definitive bone bridging and stability at 4 weeks postop.  But for the younger patients I do see this quite often.  Therefore, the age of the patient will be a factor in what my expectations are regarding the amount of time it takes for the bone to heal and have adequate stability.
 
Compliance can be another factor.  For example, some patients might initially stay off her foot and then pull weight onto soon and laterally cause a refracture and motion of the fracture or osteotomy site.  This can reset the clock.  One might expect to see bone callus and secondary bone healing in this case.

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