Principles of Fracture Healing video An animated description of the process and stages of fracture healing.
Fractures are broken bones.  There is no difference between a broken bone and a fractured bone.  Good treatment is necessary to give a broken bone the best possible chance of healing correctly.  Treatment consists of: Assessment of skin, nerves, and blood vessels Fractures can poke through the skin.  This increases the risk of infection dramatically and often requires surgery to wash out the area and fix the bone followed by antibiotics.  This is known as an open fracture.  It has also been called a compound fracture.  Broken bones and associated swelling can put a lot of pressure on nerves and blood vessels.  This can prevent blood flow to the hand or foot which can cause further damage.  Or it can do damage to the nerves which can lead to numbness, tingling, and a loss of sensation or the ability to move some muscles. Aligning the bone Many fractures are nondisplaced.  This means that there is a crack through the bone but the fragments are well aligned and in place.  When a fracture is displaced, it means that the bone fragments are not well aligned.  The ends may be pushed away from each other.  The bone may be rotated or sitting at an angle.  In order to give the bone the best chance of healing correctly, the fracture should be reduced.  This means that the bone fragments are set, or pushed back into alignment.  This may be done simply by pushing and pulling on the bone.  This is called a closed reduction.  Sometimes it is impossible to realign the bone fragments and get them to stay in place without surgery.  Whether a closed reduction or an open reduction (surgery) is performed, anesthesia is provided to limit pain.  When a fracture is evaluated in the emergency department, it may be determined that the reduction does not need to be done right away.  In this case, the fracture is splinted to make it more comfortable and to keep it from displacing any further.  Follow-up plans are made for a closed reduction or surgery at another time. Immobilization and limited activity Once the fracture is well aligned, it is important to protect the bone so that the fragments do not displace (move out of alignment).  This may be done with splints, casts, braces, or surgical hardware.  Immobilization is also important for fracture healing because too much motion across the fracture site can delay or prevent healing.  Even in a good splint or cast, too much use of the injured limb can cause too much motion at the fracture site.  Weightbearing and activity with the injured limb should be limited. Pain control Broken bones are painful.  Pain control with acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and sometimes narcotic pain medication is appropriate when the fracture first occurs.  Once the fracture has been set and immobilized, pain improves.  And so pain medication is not usually necessary after the first few days.  Ice and elevation is very important in reducing swelling and inflammation and plays an important role in pain control. Follow-up Follow-up visits after initial treatment of a broken bone are important.  X-rays are obtained to ensure that the bone is healing well.  Splints and casts can cause skin problems and need to be checked periodically.  It is also important to know how long to immobilize a fracture.  Immobilization that lasts too long can lead to stiff joints and loss of range-of-motion.  Immobilization that is too short can lead to poor healing.  Sometimes physical therapy is necessary to help with range-of-motion, strength, and function. It is very important to take good care of the fracture at home.  This can be done by following these directions: Ice and elevate the injured area as much as possible.  Do not place the ice directly on the skin, as this can damage the skin.  Do not allow the ice to melt and leak onto a splint or cast. If you were placed into a splint or cast, keep it clean and dry.  If it gets wet, breaks down, begins to rub on the skin, or becomes too tight or too loose, contact whoever put it on.  If you are unable to contact them, go to the emergency room to have it evaluated. If you experience worsening pain, an increase in numbness or tingling, or color changes, contact the whoever is caring for the fracture.  If you are unable to contact them, go to the emergency department to have it evaluated. Rest the injured limb.  Follow directions you received regarding bearing weight and activity. Take your pain medication as prescribed.