How Do Broken Bones Heal?

With summer now winding down – we can reflect on the memories of having fun: water slides at Elitch Gardens, basketball and kickball in the park, riding bikes and scooters around town and skateboarding. Every once in a while during those activities, you may twist an ankle or fall on an arm, which leads to a broken bone. As a doctor in Denver Health's Adult Urgent Care Center, I treat broken bones every day, year round – not just during the summer time.

For patients, understanding how broken bones heal is interesting, and it will help you understand why your doctor recommends a certain treatment of your fracture. (If you break a bone you may hear someone call it a “fracture,” which is just another way of saying a “broken bone.”)

What Are Bones Made Of?

Bone is made up of an inner layer called the marrow and an outer layer called the cortex. The marrow is thick but soft, kind of like peanut butter. The bone marrow’s job is to make new blood cells for the body. The bone cortex is the hard outer part of the bone that gives your bones their strength. After you break a bone we want to give the cortex the best chance to heal so that your skeleton can get strong again.

How Do Bones Heal?

There are two main ways that a doctor can help your bone heal. We pick the best choice based on the type of broken bone that you have.

• Surgery: For bones to heal, the broken pieces need to be close to each other. Sometimes the pieces of the broken bone cannot be put back into a place where they will heal on their own, or sometimes the broken bones will cause a joint to not work right (joints are places that bones move next to each other like the shoulder, ankle or hip). In those cases, it takes surgery to get the bones in the right place. During surgery, the doctor will use a special type of metal to hold the bones together in the right position. Once the bones are held together with the metal they generally heal up very well.
• No surgery: Other times your doctor will be able to get the broken pieces of bone to line up in a good location where the bones will heal on their own without surgery. Some other fractures are so small that the bones will heal without needing to move the bones at all.

Healing Process of Broken Bones

How bones heal after a fracture is a cool process. Right after you break a bone, the cells in the bone marrow send out a call for help to other cells in the body to start the healing process. This causes a lot of swelling around the broken bone (also called inflammation).

While you see swelling on your skin, inside the bone the blood from the fracture and other cells that heal broken bones are working hard to form a soft callous. The callous is a soft bridge between the broken parts of the bone, and it is the start of the healing process. It takes about one week for this soft callous to fully form. Just like the name says, a “soft” callous is not real strong bone.

So, once the soft callous is in place, osteoblasts (which are cells that act like the construction workers of the body to build up bone) get to work and start putting calcium and other minerals into the callous, which turns it into real hard bone. This is a slow process. It can take three weeks to six months for the body to change the soft callous to strong bone. You generally need to wear a cast or splint until this new hard bone has replaced the soft callous.

How Broken Bones Heal for Kids

Children’s bones are a little different in how they break and how they heal from being broken. Before kids finish growing, their bones have areas called growth plates. The growth plates are where new bone gets made so that kids can grow. These growth plates are generally near each end of the bone – on the forearm there are growth plates by the wrist and others by the elbow. The growth plates are generally “softer” than the rest of the other bone, which makes it easier for kids to break the bone at the growth plates. Most of the breaks at the growth plates heal well, but sometimes a broken growth plate needs to be held together with a surgery so that the bones keep growing in the way that they should.

On the other hand, because kids’ bones are still growing, they heal faster than adult bones. It turns out that the parts of the bone that help bones grow are the same parts that help fractures heal. So kids’ bones heal quick. It is amazing to watch how a kid’s broken collarbone will heal back to where you can barely tell it was broken after a year or two.

How to Help Broken Bones Heal Faster

Broken bones usually heal and get strong again, but not always. When broken bones don’t heal back together it is call non-union, and that can cause a lot of problems. Here are some things that you can do to help broken bones heal well:

• Do not smoke cigarettes or vape. Anything with nicotine in it will make it so less blood gets to the broken bone, and this makes it hard for the broken bone to heal.
• Taking vitamin D can help heal broken bones. In the summer time almost everyone makes enough vitamin D in their body just by being in the sun. But if you break a bone in the winter time, taking extra vitamin D can help a broken bone heal better (you should take 800 IU of vitamin D per day while your fracture is healing).
• Vitamin C and vitamin E may also help broken bones heal faster.

Spencer Tomberg, M.D. treats patients at Denver Health's Adult Urgent Care Center. He specializes in sports medicine.