How Long Should a Broken Bone Take to Heal?

Two things about that table matter more than the numbers in it.

The tibia is slow, and that is normal. It is the bone people worry about most, because at eight weeks a shin fracture often looks as though nothing is happening. Frequently nothing much is — the tibia has a modest blood supply and a thin soft-tissue envelope, and three to five months is ordinary rather than alarming.

Union and recovery are different events. Union is the bone becoming continuous. Recovery is being able to use the limb without thinking about it, and it runs months longer — stiffness, wasted muscle and confidence all take their own time.

The numbers above assume an uncomplicated break in someone healthy. Several things move them, some of them within your control.

The injury itself

• Open fracture — bone exposed through the skin. Blood supply and soft tissue are damaged along with the bone, and infection risk rises sharply. Healing takes substantially longer.
• How much the bone shattered. A clean break in two pieces heals faster than one in five.
• Which bone, and where in it. Some regions are known for poor blood supply — the scaphoid, the neck of the femur, the lower third of the tibia.

Things that are yours to change

• Smoking is the single most damaging modifiable factor. Nicotine constricts the small vessels that feed a healing fracture, and smokers have markedly higher non-union rates. Stopping for the duration of healing is worth more than any supplement.
• Uncontrolled diabetes slows healing and raises infection risk. Blood sugar control during recovery is part of the treatment.
• Weight-bearing against advice. Fixation holds bone still enough to heal; loading it too early moves the fracture microscopically with every step, and movement is what stops union.
• Nutrition. Bone is built from protein as well as calcium, and a common pattern is a patient taking calcium tablets while eating very little.
• Anti-inflammatories. Long courses of NSAIDs may slow fracture healing. Short-term use for pain is generally fine; taking them daily for months is worth discussing.

Age matters, but less than people assume in adults. A child heals dramatically faster. Between thirty and seventy the difference is smaller than the difference between a smoker and a non-smoker.

Two words get used, and the distinction is the important part of this article.

Delayed union means healing is happening, just slower than expected. It usually resolves, sometimes with a change of plan.

Non-union means healing has stopped. Waiting longer will not fix it — something has to change.

The three-month check

By around three months a healing fracture should show visible callus on X-ray and the limb should hurt less than it did a month earlier. If neither is true, that is worth a proper look rather than another appointment in six weeks.

Signs that need attention sooner

• Pain at the fracture site that is getting worse rather than better
• Pain on gently moving or loading the limb months after the injury
• A sense of movement or grinding at the fracture
• Redness, swelling, warmth, discharge or fever — possible infection, and urgent
• Serial X-rays that look unchanged over two or three months
• Metalwork that has bent, backed out or broken on X-ray

Worth doing

• Stop smoking completely until the fracture has united. Nothing else on this list comes close.
• Eat properly — adequate protein, and calcium and vitamin D from a sensible diet or correction of a proven deficiency.
• Follow the weight-bearing instruction exactly, in both directions. Loading too early stops union; staying off it longer than told wastes muscle and stiffens joints.
• Move everything that is allowed to move. The joints above and below a fracture stiffen quickly and are often harder to recover than the fracture itself.
• Get diabetes and thyroid control checked if healing is slow.

Not worth your money

• Calcium megadoses. Beyond adequate intake, more calcium does not accelerate healing. Deficiency slows it; excess does nothing.
• Bone-healing supplements and tonics sold for fracture recovery. There is no good evidence, and they are frequently expensive.
• Massage over the fracture site in the early weeks, which is common practice and can displace a healing fracture.

Bone stimulators — ultrasound and electrical devices — sit in between. The evidence is mixed and unimpressive for routine fractures. They are occasionally reasonable in an established delayed union, and are not a substitute for finding out why a fracture has stalled.