# Time for mending in badly broken bones **URL:** \ **Category:** Factual Questions\ **Created:** [June 13, 2020, 8:56pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627 "2020-06-13T20:56:34Z")\ **Posts on this page:** 15\ **Page:** 1
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 13, 2020, 8:56pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/1 "2020-06-13T20:56:34Z")
If a forensic anthropologist (like Bones) looked at a bone that had suffered a bad break, what’s the minimum amount of remodeling that can be easily determined? (Not pulling out a scanning electron microscope or anything, just eyeballing it.) One day? Three? I ask because my niece’s long-term boyfriend was in a wreck, and it broke his hip. The surgeon used the word _shattered_. Recovery is going to be a long haul, and I’d like to give them both something hopeful to count, rather than just counting the days. Say on day 36, she might say that there have been 3 or 6 or 15 minimum remodels. ---
**Author:** ![bob\_2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bob_2/32/3341_2.png) [@bob\_2](https://boards.straightdope.com/u/bob_2)\ **Post date:** [June 13, 2020, 11:22pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/2 "2020-06-13T23:22:25Z")
As you have no doubt guessed, it varies quite a lot between individuals. A lot depends on the blood supply to the fracture area. When I broke my tib & fib near the ankle and had a titanium rod inserted, it took longer than expected to heal because the blood supply was poor. Hips are pretty complicated joints so take a lot more sorting out than a simple long bone fracture. ---
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 13, 2020, 11:31pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/3 "2020-06-13T23:31:33Z")
> [@bob\_2](#): > > As you have no doubt guessed, it varies quite a lot between individuals. Yeah, it’s complicated. Was surprised to learn that remodeling is a constant process and the entire human skeleton is replaced about every 10 years. ---
**Author:** ![StarvingButStrong](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/starvingbutstrong/32/335_2.png) [@StarvingButStrong](https://boards.straightdope.com/u/StarvingButStrong)\ **Post date:** [June 14, 2020, 9:40pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/4 "2020-06-14T21:40:14Z")
> [@GreysonCarlisle](#): > > Yeah, it’s complicated. Was surprised to learn that remodeling is a constant process and the entire human skeleton is replaced about every 10 years. All of it? Like, the bones of top and back of your skull, there’s no working joints, and I, at least, have never been coshed with anything my entire life. Once you’ve grown your skull to full adult size, what’s the point in wasting metabolism on rebuilding it over and over? ---
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 14, 2020, 9:44pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/5 "2020-06-14T21:44:34Z")
> [@StarvingButStrong](#): > > All of it? Like, the bones of top and back of your skull, there’s no working joints, and I, at least, have never been coshed with anything my entire life. Once you’ve grown your skull to full adult size, what’s the point in wasting metabolism on rebuilding it over and over? That’s what I read. But I’ve also read that bone cells have a half-life of about 25 years. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [June 14, 2020, 9:47pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/6 "2020-06-14T21:47:16Z")
> [@StarvingButStrong](#): > > All of it? Like, the bones of top and back of your skull, there’s no working joints, and I, at least, have never been coshed with anything my entire life. Once you’ve grown your skull to full adult size, what’s the point in wasting metabolism on rebuilding it over and over? Because bones are a lot more than just bone cells and calcium. To the OP: Like other people have said, there are many variables. ---
**Author:** ![Der\_Trihs](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/der_trihs/32/233_2.png) [@Der\_Trihs](https://boards.straightdope.com/u/Der_Trihs)\ **Post date:** [June 14, 2020, 10:12pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/7 "2020-06-14T22:12:33Z")
> [@StarvingButStrong](#): > > All of it? Like, the bones of top and back of your skull, there’s no working joints, and I, at least, have never been coshed with anything my entire life. Once you’ve grown your skull to full adult size, what’s the point in wasting metabolism on rebuilding it over and over? For one thing, it repairs normal wear-and-tear and chemical degradation; everything wears out even if it’s just sitting there, especially in a hot and extremely chemically active environment like the inside of a human body. Constantly destroying & rebuilding bone means it’s never really “old” until the rebuilding part of the process starts to fall behind in old age. That’s why menopause is connected to weakening bones in women; estrogen is a growth hormone among its other functions. Another part of it is that bone is adaptive; it strengthens with increased load and weakens (to a point) with decreased load. It’s not just a passive support. So for example if you wore or carried heavy things on your head a lot your skull and neckbones would likely get denser and stronger. ---
**Author:** ![Dan\_Turk](https://avatars.discourse-cdn.com/v4/letter/d/439d5e/32.png) [@Dan\_Turk](https://boards.straightdope.com/u/Dan_Turk)\ **Post date:** [June 14, 2020, 11:48pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/8 "2020-06-14T23:48:44Z")
I can just add a personal anecdote that if you break your ankle and leg in a crush accident and end up with 14 screws and two plates, you can’t bear weight for three months. And do your damned PT! ---
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 14, 2020, 11:54pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/9 "2020-06-14T23:54:27Z")
> [@Dan\_Turk](#): > > I can just add a personal anecdote that if you break your ankle and leg in a crush accident and end up with 14 screws and two plates, you can’t bear weight for three months. And do your damned PT! Yup. He’s on no weight for 3 months and PT for another 6. I’m bullying my niece to bully him into taking his pain meds, but that hasn’t been a problem so far. Hope your leg’s better! ---
**Author:** ![Blue\_Blistering\_Barnacle](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blue_blistering_barnacle/32/3386_2.png) [@Blue\_Blistering\_Barnacle](https://boards.straightdope.com/u/Blue_Blistering_Barnacle)\ **Post date:** [June 15, 2020, 7:17pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/10 "2020-06-15T19:17:34Z")
Radiologist here. Very variable as noted above. Younger patients demonstrate more and better of everything. The bone involved also affects things. Mid shaft long bone fractures upper/lower arms and legs show these findings best. The very first changes are usually (mild) bone resorption (due to hype Remus at fracture site). This may make a fracture more radiographically apparent after a week or two. Then periosteal reaction occurs, with new bone or callus developing under the periosteum at the fracture site. This is seen at and adjacent to fracture site. Usually becomes visible in about 2 weeks, but also very variable. Then bony bridging males fracture line less distinct. Remodeling occurs much later. As others have discussed, there is skeletal turnover, during which bones adapt themselves to better handle whatever routine stresses they experience (that is, stresses that don’t cause real damage like fractures). A long time ago, in residency, I’ve seen amazing sets of radiographs (teaching case, not “real life”) of an infant with femur fracture (maybe bilateral fractures). Bones were not set, just left there, with displacement and over-riding. Infant was not yet walking, so not bearing weight. The bones just healed up like magic. First, they looked all weird, like a kindergartner had glued them together side to side with too much glue. Eventually, after several (maybe 10?) years of walking, they remodeled to look essentially normal. BTW- I love watching ‘Bones’, but the show is 99.9% bullshit. Nearly as accurate as ‘House’. WAAAAAY less accurate than ‘Scrubs’. ---
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 15, 2020, 7:22pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/11 "2020-06-15T19:22:56Z")
> [@Blue\_Blistering\_Barnacle](#): > > Radiologist here. > > Very variable as noted above. Younger patients demonstrate more and better of everything. The bone involved also affects things. > > Mid shaft long bone fractures upper/lower arms and legs show these findings best. > > The very first changes are usually (mild) bone resorption (due to hype Remus at fracture site). This may make a fracture more radiographically apparent after a week or two. > > Then periosteal reaction occurs, with new bone or callus developing under the periosteum at the fracture site. This is seen at and adjacent to fracture site. Usually becomes visible in about 2 weeks, but also very variable. > > Then bony bridging males fracture line less distinct. > > Remodeling occurs much later. As others have discussed, there is skeletal turnover, during which bones adapt themselves to better handle whatever routine stresses they experience (that is, stresses that don’t cause real damage like fractures). > > A long time ago, in residency, I’ve seen amazing sets of radiographs (teaching case, not “real life”) of an infant with femur fracture (maybe bilateral fractures). Bones were not set, just left there, with displacement and over-riding. Infant was not yet walking, so not bearing weight. The bones just healed up like magic. First, they looked all weird, like a kindergartner had glued them together side to side with too much glue. Eventually, after several (maybe 10?) years of walking, they remodeled to look essentially normal. > BTW- I love watching ‘Bones’, but the show is 99.9% bullshit. Nearly as accurate as ‘House’. WAAAAAY less accurate than ‘Scrubs’. Wow, thanks for all that. Very helpful. Hey… do you know anything about the area being mildly radiated to prevent “muscle turning into bone?” Or is that the same as periosteal reaction? ---
**Author:** ![MikeG](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mikeg/32/4329_2.png) [@MikeG](https://boards.straightdope.com/u/MikeG)\ **Post date:** [June 15, 2020, 7:41pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/12 "2020-06-15T19:41:00Z")
My nephew was in a high speed car wreck and the ortho doc said the only way to describe his hip bones was “gravel”. 9 weeks in ICU and 18 months of intense physical therapy. Still amazed he survived. I’d say it was two to three years before he was back to his mostly normal self but I’m not sure you ever fully recover from that amount of trauma. ---
**Author:** ![Blue\_Blistering\_Barnacle](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blue_blistering_barnacle/32/3386_2.png) [@Blue\_Blistering\_Barnacle](https://boards.straightdope.com/u/Blue_Blistering_Barnacle)\ **Post date:** [June 15, 2020, 8:22pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/13 "2020-06-15T20:22:42Z")
> [@GreysonCarlisle](#): > > Wow, thanks for all that. Very helpful. > > Hey… do you know anything about the area being mildly radiated to prevent “muscle turning into bone?” Or is that the same as periosteal reaction? Just that it is supposed to be beneficial. The dose is relatively small, so risk should be low. It is called “heterotopic ossification”, meaning bone forming in “other” place (that is, outside of bone). While some could be due to fragments of periosteum displaced by trauma, this is largely felt that “primitive mesenchymal cells get transformed into osteoblastic tissue leading to the process of lamellar bone formation in soft tissues”. This is most likely to occur near hip (happens not infrequently with hip replacement. I don’t do radiation therapy, so I don’t do this. I can say that I’ve seen much less heterotopic bone in the past 10-20 years, prob partly due to this treatment. (Also hip replacement is less traumatic than it used to be. ) ---
**Author:** ![GreysonCarlisle](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@GreysonCarlisle](https://boards.straightdope.com/u/GreysonCarlisle)\ **Post date:** [June 15, 2020, 8:27pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/14 "2020-06-15T20:27:09Z")
> [@Blue\_Blistering\_Barnacle](#): > > I don’t do radiation therapy, so I don’t do this. I can say that I’ve seen much less heterotopic bone in the past 10-20 years, prob partly due to this treatment. (Also hip replacement is less traumatic than it used to be. ) Awesome! Thanks again. I’ll pass all of that on. ---
**Author:** ![Blue\_Blistering\_Barnacle](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blue_blistering_barnacle/32/3386_2.png) [@Blue\_Blistering\_Barnacle](https://boards.straightdope.com/u/Blue_Blistering_Barnacle)\ **Post date:** [June 16, 2020, 8:29pm UTC](https://boards.straightdope.com/t/time-for-mending-in-badly-broken-bones/855627/15 "2020-06-16T20:29:18Z")
Just thought to add that “shattered hip” may not give you this classic healing pattern I described for middle of long bones. They do heal, but you may not see much periosteal reaction, etc. This is because neck and head sit in joint. In older patients, they often replace the hip rather than wait for it to heal, but this is less likely to happen for younger patients (who heal better and have a lifetime of wear to apply to an artificial hip).