Delayed Bone Healing After Open Fracture Surgery

Open fracture of the right radial bone?

Doctor, I would like to ask about my situation.
On May 26, I was in a car accident that caused an open fracture of my right radius.
I underwent surgery to have a steel plate and two screws inserted.
It has been over a month, and my bone has not healed.
What could be the reason for this? I have been consuming foods that promote bone healing, as well as iron supplements and calcium tablets.
Is it possible that some people have a constitution that makes it harder for them to heal bones? Additionally, I have been exercising; could brisk walking affect bone healing? Or could prolonged exercise hinder bone growth? A few days ago, I had a follow-up appointment where the doctor took an X-ray and said that my bone has not healed at all.
He mentioned that, at my age, it should have started healing by now, and I could have had the cast removed.
I am very worried.
If I were to remove the cast but maintain the same position or avoid moving it, would that also prevent bone healing? Sometimes when I go out with my boyfriend, I don’t wear the cast and rest my hand on his shoulder, and he doesn’t move quickly enough to cause discomfort.
Also, does staying up late affect bone healing? Or does insufficient sleep also hinder healing? I would appreciate your answers to these questions.
Thank you.

Pei Ying, 10~19 year old female. Ask Date: 2015/07/14

Dr. Shi Guozheng reply Orthopedics

Forearm fractures (of the radius or ulna) typically require six to twelve weeks for healing, with a maximum healing time of three months.
If it is an open fracture, the healing time will be even longer.
If your physician has advised you to use a cast for protection, it is essential to follow their instructions for immobilization.
Proper fixation (with bone screws and plates, in addition to the cast) will promote faster and better bone healing.
Inadequate fixation can lead to delayed healing.
While staying up late is not related to healing, nutrition plays a significant role, and smoking can also adversely affect bone healing.

Reply Date: 2015/07/14

More Info

Delayed bone healing after an open fracture surgery can be a concerning issue, especially for young individuals who typically have a better healing capacity. In your case, having undergone surgery for an open fracture of the radius and experiencing a lack of bone growth over a month post-surgery raises several important points to consider.

Firstly, it’s essential to understand that bone healing is a complex biological process influenced by various factors. The healing process generally involves three stages: the inflammatory phase, the reparative phase, and the remodeling phase. In the case of open fractures, the healing process can be complicated by factors such as infection, the severity of the fracture, and the presence of foreign materials (like plates and screws).
One of the primary reasons for delayed healing could be inadequate blood supply to the fractured area. Open fractures can disrupt the blood vessels, and if the blood flow is compromised, it can significantly delay healing. Additionally, the presence of infection is a critical concern in open fractures, as it can impede the healing process and lead to complications.
Regarding your concerns about nutrition, it is true that certain nutrients play a vital role in bone healing. Calcium and vitamin D are crucial for bone health, and adequate protein intake is also essential for tissue repair. While you mentioned that you are consuming foods rich in these nutrients, it’s important to ensure that you are getting them in sufficient quantities. Sometimes, dietary supplements may be necessary, but it’s best to consult with a healthcare provider before starting any new supplements.

Your question about exercise is also pertinent. While light activity can promote circulation and may aid in healing, excessive or inappropriate movements can lead to stress on the fracture site, potentially delaying healing. It’s crucial to follow your physician's advice regarding activity levels. If your doctor has recommended immobilization with a cast, it’s essential to adhere to that guidance to allow the bone to heal properly. Using the arm without the cast, even if it feels comfortable, might not provide the necessary support for the healing bone.

Sleep and overall health also play significant roles in recovery. Sleep is vital for healing, as much of the body’s repair processes occur during sleep. Chronic sleep deprivation can negatively affect your immune system and overall recovery. Therefore, ensuring you get adequate rest is crucial.

If your doctor has indicated that your bone has not shown signs of healing after a month, it may be necessary to investigate further. This could include imaging studies to assess for any complications such as nonunion (where the bone fails to heal) or malunion (where the bone heals improperly). In some cases, additional interventions may be required, such as bone grafting or adjusting the fixation method.

In summary, delayed bone healing can result from a combination of factors, including blood supply, infection, nutrition, activity levels, and overall health. It’s essential to maintain open communication with your healthcare provider, follow their recommendations, and address any concerns you have about your recovery process. If you continue to experience issues with healing, further evaluation and possibly a referral to a specialist in orthopedic surgery may be warranted to explore additional treatment options.

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