the curious case of fracture healing

The human body is an amazing thing. Back in early October, I fell and shattered my left ankle in more than a dozen places. The lateral and medial malleolus were a splintered HM–hot mess. If I didn’t have access to quality surgery (not to mention 12 screws and a really long orthopedic plate holding everything together), my left ankle would certainly be disfigured. I’d also be crippled.

Just two months after surgery, I was back on both feet. Walking. Perhaps not extremely capably, but still walking. Four months later I have excellent range of motion, and my step is pretty sprightly. I am amazed to be where I am. And the process of fracture healing is an incredible journey. Follow me on this.

When you break a bone or bones, the human body springs into action. As Richard Marsell and Thomas Einhorn put it in their scholarly article, The Biology of Fracture Healing:

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.

Several thousand genes? That’s right. The process of fracture healing can be described as four overlapping stages, roughly:

  1. Inflammation. Within a few hours after the break, the body rushes blood to the break site. A protective blood clot (hematoma) is formed. Think lots of swelling, bruising. Granulation tissue forms at the ends of the fracture, and specialized cells called phagocytes eat away at any dead tissue and unwanted bacteria.
  2. Creation of a primary (soft) callus. More specialized cells–this time chondroblasts–are recruited to develop a callus made of two types of collagen at the break site. Revascularization also kicks into action, ensuring a healthy blood supply.
  3. Creation of a bony (hard) callus. The soft callus is replaced by a bony callus, which helps stabilize the healing bone. At this stage, you can thank cells called osteoblasts for mineralizing the collagen to create the bony callus.
  4. Bone remodeling. This stage is pretty cool and time intensive, taking months to years. Yes, years. (As many as nine years.) The bony callus is remodeled as lamellar bone with its own medullary cavity–the area within the bone where marrow is stored. In the remodeling stage, the bone regenerates itself. It’s nerdy cool and amazing to learn up on.

Want to get schooled on the specific biological processes in fracture healing in the medical literature? Visit here.

 

bimalleolar fracture: a user’s guide

Given the right conditions and correct stresses, bones–and sometimes spirits–wither and break. Earlier this month I had returned from visiting my sister who lives north of Atlanta to help her and my niece who had broken her elbow. En route to Georgia, my car experienced engine failure. The mechanic’s assessment: blown head gasket. What a not-so-great run of luck. My job-search efforts to that point weren’t successful; I recently replaced a couple tires; and I had no idea how I was going to find the $ to replace the engine (about $4,000). I am sure that I was stressed.

I could not have anticipated what was waiting for me when I got back home to Jackson. It was Sunday evening and, crossing my front lawn, I slipped and fell. It should have been an ordinary fall, but it wasn’t. My body fell right, and my left foot and ankle took a hard left. I felt a snap, saw my foot flop limply while an ankle bone popped out and bobbled around. I was in shock. I was in a world of physical pain but all I could think was, Holy buckets. I have neither any health insurance nor the foggiest clue on how I could pay for a broken ankle. The pain was stabbing and the ball of my foot was wobbling independently of my ankle bone, so I crawled on one knee to my house to call my neighbors for help. I knew my situation was serious enough to go to the E.R., which I did and where my ankle was temporarily reset.

Fast forward a week and a second visit to an orthopedic doctor and his assessment: bimalleolar fracture. Surgery was a must and was performed on the 18th. The surgeon plated and screwed the bits and pieces of the lateral malleolus (pictured at right) back together. Once that was complete, the medial malleolus popped back into place, and the surgeon secured that with two longer screws.

Fracture

And now for the user’s guide if you experience a similar fracture. The second day after surgery is kind of grim. Unpleasant. If you tolerate pain medication, this is the day to take it. If you have the financial means, consider getting or renting a knee scooter. The knee scooter vastly improves your ability to get around the house. I also recommend getting a pair of training gloves initially–these reduce the blisters you’ll experience from using crutch handles.

If you’re uninsured like me, prepare yourself for a small mountain of hospital bills. It’s a bit overwhelming to see what I owe. But hopefully if you’re like me, you live in an area of the country where the medical care is excellent but doesn’t cost what you might pay in a larger metropolitan area. I truly have to find any silver lining these days can afford me. My spirit kind of depends on it, for the moment.

And if my luck turns a corner, which I think it might, I’ll get fitted for a walking boot in a couple weeks, and I might be able to walk my dogs again, albeit slowly and extremely carefully. Fingers/toes crossed.