Broken bones
Why do bones heal? “Because they are broken”
- Graham Apley.
The above answer has been imprinted in my mind, as one of the first few quotes I had come across as a postgraduate more than 25 years ago. Every time a patient asks me about his or her fracture and its healing characteristic, it comes to my mind and that is practically every day, with me being an orthopedic surgeon.
As we get older and “wiser” we get the strength to admit what little role we get to play in the scheme of things by nature. Why do bones break? The commonest being an impact, which loads the bone to failure. Bones are relatively plasticky and can absorb small amounts of load. The second being a minimal impact, which by itself when applied once, will not lead to a fracture, but when applied multiple times, can lead to a small crack, which propagates, these are called stress fractures. The other reason being a sick bone or a diseased bone, which has become weak and is unable to withstand smaller impacts and fails.
We might have observed the commonest animal on the street: a stray dog, limping on three limbs when it is injured, over period of days, it slowly brings the injured limb into utilization. As the injury heals, the pain reduces and it starts to run on all fours. No one has treated it! So, the fractures heal because the bone is broken.
Why and what for do we intervene. Many of the fractures heal in a plaster cast or a splint. The healing depends on the age of the patient, location of the break and the damage to the tissues at the time of injury. The cast allows us in some instances to give rest and let the fracture heal in an optimal position. In some scenarios, we operate, the reason being unlike animals we want to return to normal activity with full function, for which we need to restore form. The above-mentioned variables remain the same, over which we have no control. Therefore, the time taken to heal remains the same, in fact it may be prolonged further due to the interference of surgery, but it’s a tradeoff worth taking in our quest for return of normalcy. Other than surgeon factors its these factors which occur at the instant of injury, that lead to complications like delayed healing or not healing at all. In routine clinical scenarios, surgery can make things worse, but cannot make bones heal faster. Orthopaedic surgeons have the privilege of assisting nature in its work, rather than being able to substitute it. When complications do occur, either of them could be responsible.
How do we get our bones to be stronger and less susceptible to injury? Eat healthy, exercise regularly and avoid smoking.
Bone is the only structure in the body which doesn't have a scar when it heals. Its magical.