Upper Limb Fracture Healing | Plenty Physiotherapy, Bundoora

Upper Limb Fracture Healing Document 

An upper limb fracture refers to any break or crack  in the bones of the clavicle, humerus, elbow, wrist,  or hand. These injuries range from: • Simple (non-displaced) fractures • Complex (displaced, comminuted, or open)  fractures They may result from high-energy trauma (e.g.,  motor vehicle accidents, sports injuries), low energy trauma in osteoporotic bones, or stress  fractures due to repetitive loading. Fracture healing principal timeline:  1) Inflammatory phase (1-7 days): Straight after a broken bone, it results in torn  blood vessels and the formation of a blood clot or haematoma. The  inflammatory reaction results in the release of cytokines, growth factors and  prostaglandins, all of which areimportant in healing and move towards the site  of the fracture.  2) Repair phase (Week 1-6): During this period, bone-forming cells are recruited  from several sources to help form new bone. Soft callus is organised and  remodelled into hard callus over several weeks. Soft callus is plastic and can  easily bend if the fracture is not supported well enough. Hard callus is weaker  than normal bone but can withstand higher forces and equates to the stage of ‘Union’. 3) Remodelling phase (Week 6- 1 to 2 years): In this stage, the longest phase, the  fracture heals and the surrounding callus responds to activity, external forces,  functional demands and growth. Part of the bone (external callus) which is no  longer needed is resorbed and the fracture site is sculpted into its usual shape.  The structure of the bone at this stage restores strength and function.  Sites of common upper limb fractures and their potential typical healing  timeframes: A) Clavicle: The Clavicle (Collarbone) can often be fractured from high-impact  direct trauma to the shoulder region such as during sporting incidents, or from  falling onto an outstretched hand. Healing for this can often take up to 6-8 weeks. In saying this, the exact timeline can vary based on the severity of the  fracture, the patient’s overall health, and rehab protocols. B) Humerus: The humerus can often be fractured from high-impact direct trauma  incidents, sporting incients and falls. Healing for this can often take up to 8-12weeks. Despite this, the exact timeline can vary based on the severity of the  fracture, the patient’s overall health, and rehab protocols. C) Elbow: The elbow can be fractured from high-impact direct trauma incidents,  particularly falling onto your elbow. Healing for this can often take up to 8-12  weeks. However, the exact timeline can vary based on the individual case. D) Radius and Ulnar: The radius and ulna (forearm bones, distally towards the  wrist) can be fractured from high-impact direct trauma incidents, particularly  falling onto an outstretched hand. Unfortunately, both these bones can fracture  simultaneously. Healing for this can often take up o 8-10 weeks, but can vary greatly. E) Scaphoid: The Scaphoid bone is often fractured when falling onto an  outstretched hand. Healing for this can often take up to 8-12 weeks. However, this can vary as some cases can be more complex if the fracture is displaced and dependent on whether the blood supply of this region is reduced/cut off  from the fracture location. Treatment and management:  

1) Bracing and Immobilising: Each fracture differs in complexity and is influenced by  the region of the body affected. Utilising a brace, cast or boot to minimise  aggravating positions, limit loads, and reduce pain. This will help where  necessary to facilitate the healing process.  2) Medical: There are scenarios where certain fractures will require surgical  intervention. This may be due to the fracture being complex and needing  alignment and/or the fracture failing to commence normal bone healing  processes. In surgery they will help re-align the fracture and stabilise the bone  using internal fixation devices such as rods/plates and screws, so that the  fracture can begin to heal. Medication for pain management will also be crucial.  ) Physiotherapy: Regardless of surgical intervention, physiotherapy will be vital in  progressing an individual in relation to their range, strength, functional demands and pain management. Specified exercises to help target these, as well as  manual therapy techniques such as soft tissue and mobilisations will be  incorporated to promote healing, reduce complication risks (such as frozen  shoulder), optimise utility of exercises, and aid pain management.