The healing of bones during fractures is always an interesting process which the body is always capable of. If given the proper conditions, some fractured bone can heal back to their normal conditions without actually developing bone scars especially if the injured person is still young, have a healthy bone condition, had enough healing time and the surgeon has done a good job with the repair. When there is the callus formation on the bone’s fracture site during bone healing, this formation is called the fracture callus. There are two ways how the process of fracture healing undergoes and these are the direct or primary bone healing and the indirect or secondary bone healing.
Types of Fracture Callus
• Primary healing is the process wherein the bones will try to re-establish themselves after the fracture happens. The bone on the other side of the cortex will try to unite with the bone that is on the other side and then do the mechanical continuity of the healing process until fractured callus appear. However, this can only occur if proper treatment procedures such as closed bone reduction, rigid internal fixation, or when the severe fracture undergone a bone fragmentary repair and was treated accordingly.
• Secondary healing of bones can have many stages of healing such as the following:
• Impaction stage. This is the stage when the bone encountered a strong impact and then the healthy cells respond to stimuli, releases local biochemical, and biophysical messengers to enable surviving cells to respond and encourage healing.
• Inflammation stage. When hematoma and hemorrhage form due to the breakage of the bone and damage the blood vessels, lysosomal enzymes will be released and leukocytes, macrophages and other inflammatory cells will invade the damage area to protect it.
• Primary soft callus formation stage. The cells that were stimulated and sensitized will begin producing fibroblasts, intracellular materials and new blood vessels. Granulation tissues will also begin to form in this process.
• Callus mineralization stage. About after 1 week after the fracture is joined, mineralization of soft callus begins. Osteoid will also form and this consists of opaque calcium hydroxypatite. This mineral will make the callus rigid.
• Callus formation fracture remodellation stage. This consists of the replacement of old callus with new packets of callus as the osteoclasts will be remodeling the outside surface of the bone. Gradual decrease of the size of the callus will also take place and the supply of blood plus the oxygenation and pH condition of the bone will return to normal. The mineralized cartilage is now replaced with woven bone and then this will be replaced with new lamellar bone.
The use of X-rays or radiography is the most common method in evaluating the healing of fractured bone and it is also used in evaluating callus bone fracture formation. It can be able to visualize the formation of callus after mineralization takes place. Histology is also another form of evaluating bone fracture healing. The surgeon will check for marrow changes, cortex remodeling and bone union by means of monitoring the bone’s progress though the application of CT scans, MRI or bone scanning. Densiometry is also another form of diagnosing bone healing with the use of radiograph and bone mineral content (BMD) analysis. Rehabilitation or rehab is needed.
If we know how bones can fracture, we must also have a background how healing can take in many forms and what causes healing. Healing can take in many stages. From the time the fracture is sustained, there would be the inflammation of the injury followed by bruising. This manifestations show that the damaged tissues are showing reactions to the injury thus the body is releasing leucocytes or white blood cells to combat infection and let natural healing takes place. This will be followed by the formation of soft callus and eventually will be replaced by hard callus. The final stage is bone remodeling or the bone will be healing itself until it stays as it was before.
Fracture Callus Symptoms
The symptoms of fracture callus or indicators of bone healing will be visible through x-rays, CT scan or MRI and these are:
• Formation of soft cartilage 2 and 3 weeks after the injury
• About 4 to 8 weeks there will be formation of hard cartilage which will be replacing the soft cartilage
• About 8 to 12 weeks after the bone is fractured, the fractured site remodels itself.
Fracture Callus Treatment
For bone to heal properly and completely there must be different procedures that must be done. There are the most common methods of treatment which doctors use to heal broken and fractured bones and these are the use of casts or splints, surgery, and bone replacement. Cast and splints are the usual procedures for fractures that only need immobilization to keep the bones from displacing. These methods are usually used on simple fractures like greenstick fractures and undisplaced transverse fractures. Moreover, surgery would be relevant if the fracture already affects the muscles or organs that are near the fracture. In addition, this is very applicable for open fractures that require the need to repair the bone, skin, tissues, and internal organs that have been damaged by the splintered bones.
Bone replacement will be in application if the fracture is so severe the bone would be in irreparable condition. The severely damaged bone should be removed and will be replaced with a synthetic analogue that is usually made of titanium. This metal has the same strength and structure of the original bone and sometimes even exceeds the rigidity of the human bone.
Recovery Time & Healing Time: It may take more than 4 weeks.
Prevention of Callus Injury
Although almost bone fractures can be repaired (thanks to the technology bone surgeons use today), there must still be effective ways not to have bone fracture in any way. Remember that once a bone is fractured and then healed, its original density, rigidity, flexibility, and toughness will not be the same as when it was uninjured. Therefore, being cautious in doing things that can possibly hurt us and doing measures to prevent accidents is the best preventive measures one can have. We already have invented body pads, protective gloves, helmet, knee pads, wrist bands, and many more just to make parts of our body protected so better utilize them.
When to Call a Doctor
When a fractured bone has healed, it will still undergo remodeling for years. Sometimes it would take even a decade to completely heal a bone back to its original state so there is always the risk that the bone can break again if an accident happens. When a bone breaks where the same spot the fracture occurred, it will show the same symptoms of swelling, bruising, and deformity. Call for medical assistance as soon as this happens. Also, if the healed and fractured bone suddenly became painful, consult this as well with your physician. This is an indication that the bone is experiencing stress again or developing stress fractures.