Bone healing or fracture healing occurs in between the fixed fracture ends. Formation of new bone tissue is a biological process.
The biology of fracture healing is a complex biological process that follows specific regenerative patterns and involves changes in the expression of several thousand genes.
This process may show some positive or negative changes depending on many factors such as the age of the person, the region of bone fracture, and th e type of the fracture. For example, the healing process of two different bones in the same person may be different. Or similar fractures in the same area may heal quickly in one patient, while in another, union may be delayed or even not. Factors that may affect the rate and the degree of the healing of broken bones are examined in two main categories, local and systemic factors.
Local factors relate to conditions and structure of the broken bone.
The fracture must be fixed very well. One of the most important factors in the fracture healing is the controlled immobilization and the bridging of ends of broken bone segments. This needs a correct mechanical environment at the fracture site and to some degree dictates, which healing process takes place. It is common practice to employ orthopedic fixators for this purpose, and to align the bones correctly.
An intraarticular fracture is a fracture that crosses a joint surface. Such fractures also involve some cartilage damage. Fractures to joints are more complicated to treat and heal than simple fractures, as multiple bones are involved.
When the broken ends are distant from each other, the healing is delayed, or never occurs. Therefore, the recommended amount of bone lengthening for adult height increasing surgery is 1 mm per day. More lengthening can weaken the connection between the bone tips and negatively affect bone union.
Pathological conditions in the fracture may delay recovery. Any infection or bone inflammation that occurs in bone, negatively affects bone healing.
Most reproducible experiments show that radiation may delay fracture healing.
Systemic factors that influence bone healing relate to the overall condition of the patient’s body systems: such factors might be patient age, nutrition status, activity level, nerve function, hormones and drugs.
Age is a major factor in the healing process of any broken bone. It is faster in children than in adults.
Regulate blood supply well for lack of it will drag down the healing process. This is one of the factors affecting bone healing especially in parts such a scaphoid bones, talus, and femoral head.
Sufficient amount of nutrients are essential for the healing of broken bones. Nutrients like carbohydrates and proteins are required in adequate quantity.
Smoking has a negative effect on bone healing, in terms of delayed union, nonunion and more complications.
Steroids also can slow down the healing process.
Systemic diseases such as hyperthyroidism and renal insufficiency delay fracture healing.
Genetic diseases such as Marfan Syndrome, Ehler Danlos Syndrome (Soft Tissue Disorder), Osteogenesis Imperfecta (Glass Bone Disease) are among the factors affecting bone boiling. Because the presence of these diseases cause broken bones to heal slowly.
A sufficient dose of vitamins A, B, C and D required for bone development is essential. The intake of vitamins A and D in a fraction of a dose would delay healing, rather than healing the fracture. Most natural form of vitamin D can be obtained from sunlight. For example, sunbathing legs after limb lengthening surgery will be beneficial in terms of vitamin D supplementation. Calcium-containing foods such as yogurt and milk are also factors that accelerate healing.
When a blood vessel leaks into surrounding tissue, it forms a bruise. The bruise, which commonly known as gangrene, is a sign of healing. The cells that will repair the fracture area are bruised due to the collection in the fracture area.
The electric current supplied to the area where the fracture is, causes fast healing.
Doing “exercises” or “weight-bearing” to the region of the fracture accelerate recovery. For this, however, the fracture must be very well fixed. For example, in cases where external fixators are used, the patient’s walking with load causes pressure on the bone and accelerates the healing.
Ultrasound devices that accelerate bone healing in physical therapy centers can also be used.
Sleeping well and avoiding stress can affect fracture healing.
In conclusion, factors affecting bone healing are extremely important. It should not be forgotten that the formation and reconstruction of the bone is a process that takes months. Before decision for leg lengthening surgery one must review these factors.