Bones Broken Hand Hand Hand Therapy

Advice from a Certified Hand Therapist: How Do Broken Bones Heal?


Have you ever wondered how a broken bone heals? Broken bones, also called fractures, can heal two different ways.  The two types of bone healing are primary and secondary bone healing.  Secondary bone healing is more common than primary bone healing.

Secondary bone healing occurs when there is slight, controlled motion between the two ends of broken bone during the healing time.   For example, slight motion occurs when the broken bone is set in a cast.  Once the broken bone has been aligned back to its normal position and is placed in a cast, proper healing can begin.

In addition, secondary bone healing progresses through different stages.  The first stage occurs immediately after the fracture.  In this stage, there is swelling and bleeding around the broken bone.  The bleeding then becomes a mass around the break.  This mass is first known as a soft callus and eventually becomes a hard callus.  Once the soft callus becomes hard, the bone is stable.  After a cast is removed, the hard callus is gradually remodeled to normal bone.  This can take up to several years.

Primary bone healing occurs when there is absolutely no movement between the two ends of a broken bone.  The goal of surgery is often to stabilize the bone so that primary healing may occur.  Doctors may use rods, pins, plates, or screws to hold the broken bone together.  This hardware presses the ends of the broken bone together tightly and prevents any movement.  When there is no motion, new bone begins to form immediately across the two ends of broken bone.  In this case, there is no callus that forms around the break.  At first, the hardware holds the break in a very stable position and then new bone grows across the site resulting in a once again normal bone.

Every broken bone is unique.  The decision to cast and allow secondary bone healing to happen or to fix with surgery and allow primary bone healing to happen is made by your doctor.  The ability to realign the pieces of bone and have them stay in a good position for healing will be considered.  Your doctor will also consider the typical activities you are involved in and your health.  With all of these things in mind, your doctor will make a decision that is best for your break and for you so that healing can begin.

Some bones heal quickly and others more slowly.  The speed at which a bone heals depends on the size of the bone, the severity of the break, and the amount of nutrients and blood supply around the bone.  Other things that affect the body’s ability to heal a broken bone are age, general health, and nutrition.  Children tend to heal more quickly than adults do because of the strong tissue around the bone that provides good nutrients for healing.  As people get older, their tissue gradually thins and healing can take longer.  When health issues are present, such as infection or disease, this can also slow the healing process.  A healthy, well-balanced diet will help bone to heal.

X-rays are used to decide if a bone is healed enough to allow use of the injured arm or hand for daily activities.   Once the bone is healed enough for exercise and use, your doctor may send you to a hand therapist to guide you through specific exercises.  With your therapist you will work to gain back your motion, strength, and function.

Courtney Middleton, OTD, OTR/L, CHT, CLT is a certified hand therapist and a member of the American Society of Hand Therapists (ASHT).

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  • Brenda Anderson
    September 28, 2019 at 7:47 AM

    Thanks for this.

  • Shirin Sheppard
    August 30, 2019 at 12:09 AM

    The bone in my little left finger tip was broken 2 years ago, completely into 2 pieces. I had a surgery to stabilize the fracture. Today I don’t have pain in the finger but the finger tip at the nail sticks up at an angle it never used to and doesn’t look straight (for instance if I clap my hands together it sticks out a bit). This did improve slightly over the first 6 months or so, but it never went back to normal. I always wondered whether the bone fragments were aligned properly in the first place or whether there’s still bone callus which is causing the odd shape? If it’s callus will it continue to get smaller over time? Will the finger ever return to its normal condition? Thanks!

  • Jane Bressler
    March 13, 2019 at 9:33 AM

    I broke my wrist on January 22, 2019. Cast was removed March 7, 2019. I don’t start hand therapy until March 18th. I still can’t make a fist and my wrist is so painful that I can’t move it in any direction. I’m wearing a brace which I can’t even do much with it on. I take it off to try and make a fist but just isn’t happening. Is it possible that the radius fx is still not totally healed hence all the pain?

    • May 31, 2019 at 11:19 PM

      it is not a problem,see my hand iam approach a doctor after 2 years later when it happent period to surgical time

  • Ravnil Kumar
    February 21, 2019 at 12:03 PM

    Hi i have radial head crack and its paining alot cannot move my hands. Any suggestions towards healing will be helpful.

  • Katherine Johnson
    January 16, 2019 at 11:06 AM

    Why is my shoulder pulling with constant pain, throbbing.

  • Lourdes Kelly
    December 19, 2018 at 6:27 PM

    I had internal fixation of the right wrist after a fracture a month ago. Is it normal to have intense pain and swelling in the hand/thumb at this time?

    • December 19, 2018 at 7:50 PM


      We highly recommend that you call the surgeon who performed your surgery about your pain as soon as possible. The longer you wait, the higher your risk of developing a serious problem.

      American Society for Surgery of the Hand

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