Fracture of the lower limb bone is common. It occurs when there is excessive mechanical stress on the supporting skeleton. Any falls, traffic accidents, accidents or fights can lead to a fracture in one place or another. Everyone experiences pain at the site of a fracture can occur not only immediately after a fracture, but also while wearing a cast, after its removal, and for a very long time .
Photo 1. The fracture site may hurt, even if the bones have long grown together. Source: Flickr (kenga86)
Why does pain occur at the fracture site?
A bone fracture is a violation of its structure with the separation of one part of the bone from another. The parts formed as a result of a fracture are called fragments.
There is a myth that bones cannot hurt. In fact, this is a common misconception. Bone structures have good innervation and a rich receptor field .
Bone is not a solid structure. Tubular bones consist of compact and spongy substance, a medullary canal covered with endosteum, and bone marrow.
Flat bones do not have a medullary canal; the bone marrow in them is located between the trabeculae of the spongy substance. All bones are covered on top with periosteum.
Bone pain receptors are unevenly distributed . Most of them are in the periosteum area. Injuring it is accompanied by severe pain. The bone substance itself has much fewer nerve endings.
The next receptor field is located in the endosteum and bone marrow. Deep fractures with injury to the medullary canal increase the intensity of pain .
Pain syndrome after a fracture
Pain is a protective reaction of the body. It is a signal that there is a pathological focus somewhere in the body. When a fracture occurs, intense pain signals that the integrity of the bone is compromised .
It is important! It is pain that forces the victim to stop mechanical impact on the injured area. Pain in this sense is a blessing, since excess stress can only aggravate the situation.
While wearing a cast
A plaster splint is necessary to ensure the immobility of the fragments. This, in addition to accelerating their fusion, should reduce pain. However, often, a few hours after applying the splint, the pain intensifies. This is not due to the receptors in the bone itself, but to the tissues around the fracture.
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In this case, the pain occurs due to swelling . The swollen tissues increase in size and put pressure on the nerve endings, causing pain. Edema occurs as a consequence of two processes:
- Inflammation . Any injury leads to cell damage and inflammation. This, in turn, is always accompanied by swelling. It can be expressed quite strongly if a lot of exudate accumulates in the tissues.
- Venous stagnation . Blood inflow is an active process, and outflow is a passive process. Blood flows out due to the work of muscles. When the fracture is immobilized, the muscles are unable to move, which reduces venous outflow. In this case, fluid from the veins enters the surrounding tissues and causes swelling.
After removing the plaster
The plaster is removed if the fracture has almost healed. However, in this case, pain may also occur. It has several reasons:
- Bone pain . After removing the splint, the fourth stage of bone tissue restoration—remodeling—starts. In this process, special cells called osteoclasts break down certain areas of the bone to give it the desired shape. Then other cells - osteoblasts - restore the normal structure of the bone substance. The process of physiological bone breakdown can be painful.
- Muscle pain . Due to immobilization, the muscles are deprived of movement and adequate blood supply for several weeks. This leads to atrophy. The process of restoring atrophied tissue is always quite painful.
- Mechanical pain . While wearing the splint, there was no mechanical impact on the fracture site. Now, the resumption of the load again causes irritation of the muscles at the fracture site, which is accompanied by short-term pain.
What happens during a fracture
When a fracture occurs, destruction of bone tissue occurs, which can be traumatic (for example, as a result of impact or compression) or pathological (for example, as a result of the development of osteoporosis or tumors) in nature. Damage also occurs to the tissues surrounding the bone: muscle fibers, nerves, etc. If we are talking about an open fracture, then the bone comes out, violating the integrity of the skin, and the injury communicates with the environment. But even with minor closed fractures, there is a rupture of the surrounding soft tissue to one degree or another. Damage to nerve fibers is the main source of pain. For the same reason, a person may experience numbness.
During the healing process, cells cannot restore their previous structures one hundred percent. One way or another, scars, micro-tears, and heterogeneous areas remain. This is true for both bone and soft tissue. Many of us have seen thickenings on the bones on x-rays after removing the plaster - this is precisely their nature.
Newly formed bundles of nerves also pass through these areas (a big hello to those who still believe that nerve cells do not regenerate). And it is here that they are least protected from the influence of the external environment, and with age their sensitivity will increase.
Another unpleasant result is damage to the blood vessels, which subsequently impairs blood supply. Trying to restore it and speed up metabolic processes, a person instinctively massages and kneads the site of a healed fracture. Disruptions in the supply of oxygen and nutrients also weaken tissues and lower the pain threshold.
Together, these factors give rise to such a phenomenon as pain in an old fracture.
Important! Domestic scientists have developed a drug that reduces the likelihood of repeated injuries in places of old fractures!
Why does an old fracture hurt?
If the bone fragments are completely healed, the old fracture should not hurt. However, for some people, the pain returns after several months or even years. Most often, unpleasant sensations occur when the weather changes . The mechanism of their appearance is not precisely known.
The only explanation is the change in atmospheric pressure when the weather changes, which affects the state of body fluids. In this case, the blood plasma and intracellular fluid change their configuration. This does not affect normally functioning tissues, but causes changes in fracture sites, sutures and scars. The cells in these places are already changed, and when the weather changes, they may become subject to inflammation and degeneration.
This explains why sometimes aching pain of varying intensity occurs at the site of an old fracture. In addition, sometimes such pain is caused by improperly fused nerve endings at the fracture site.
How to relieve pain syndrome
Immediately after a fracture, pain is relieved with non-narcotic analgesics . If they are not effective, they resort to the use of narcotic morphine-like substances.
This is interesting! Sometimes after a fracture the victim does not feel pain at all. Unpleasant sensations arise only after a few hours. This is due to the fact that after an injury, a large amount of adrenaline is released into the blood, which is able to mask pain impulses. This explains why, even after multiple compound leg fractures, some people are still able to walk independently for some time.
If pain occurs due to swelling, it is necessary to take non-steroidal anti-inflammatory drugs and diuretics . If pain occurs after removing the cast or at the site of an old fracture, you should stop any impact on the fracture area and take a non-narcotic analgesic.
Photo 2. There is no need to endure the pain; it is recommended to take an analgesic immediately after the fracture. Source: Flickr (Tailyn Osorio)
How long does pain last after a fracture?
Immediately after a fracture, pain may continue for several hours after immobilization. It then occurs due to swelling after 12 hours or several days and continues until the swelling decreases.
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After the plaster cast is removed, the pain may last up to a week.
The occurrence of unpleasant sensations weeks , months or years after the fracture indicates possible malunion. However, if such pain is of a mild, aching nature and goes away on its own, there is nothing to worry about. For some people, the bones at the site of the fracture ache when the weather changes throughout their lives.
In what cases should you consult a doctor for pain in old fractures?
The appearance of discomfort years after the injury may indicate improper bone healing. However, in most cases we are still talking about painful sensations that are born in the remaining scars and tissue adhesions. In such cases, you can do without medical help. We recommend contacting an orthopedic specialist in the following situations:
- there is severe pain that does not go away over time or occurs periodically;
- it is not possible to get rid of pain with the help of analgesic drugs;
- severe swelling or discoloration of the skin at the site of an old injury;
- pain does not allow you to perform work or daily household operations.
When to contact a specialist
You should consult a doctor if:
- The pain is very intense;
- Analgesics do not help stop it;
- Due to swelling, the leg begins to turn blue;
- Painful sensations go away only when taking medications, without which they bother you constantly for several days;
- Because of the pain, it is impossible to perform usual work even several weeks after the splint is removed.
Consultation with a traumatologist / Maria, Essentuki 7975 September 2019
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Answers from doctors + 1Complain Konstantin Tishchenko, September 19, 2019 Orthopedist, Traumatologist + 1Complain Vagiz Muzafarov, September 19, 2021 Orthopedist, Traumatologist Pain after fractures can occur for a long time, as various inflammatory and degenerative processes form at the fracture sites and their contact with the ligaments. All this needs to be removed with anti-inflammatory therapy: ComplainVagiz Muzafarov, September 19, 2021 Orthopedist, TraumatologistComplainVagiz Muzafarov, September 19, 2021 Orthopedist, Traumatologist Hydrocortisone + 1ComplainYakov Martirosyan, September 20, 2021 SurgeonComplainMaria, September 20, 2019Client Yakov, that’s me It’s embarrassing that the pain is not in the place of the fracture . I added a photo. + 1Complain Yakov Martirosyan, September 20, 2019 SurgeonComplainMaria, September 20, 2019Client Yakov, only 20 days after the injury she wore an elastic bandage and rest, a minimum of movements. Warming compresses. + 1Complain Yakov Martirosyan, September 20, 2021 Surgeon Similar questions on the topic Consequences of a fracture1 answer August 28, 2018 Irina, St. Petersburg Question closed Shoulder pain 2 answers January 17 Sergey Question closed Knee injury 13 answers January 23 Alena, Yaroslavl Question closed What should I do if I haven’t found the answer to my question?
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- What to do if your left leg swells in the foot, ankle, lower leg
Consequences of a bone fracture
A fracture is a partial or complete disruption of the integrity of a bone, which can be traumatic or pathological. The cause of damage may be loads, impacts or other external influences, as well as various diseases that worsen the condition of the bones and make them fragile. Regardless of the type of fracture (open or closed), it disrupts not only the integrity of the bone, but also the soft tissue around it, including the nerve fibers through which the nerve impulse passes. This is why a person after an injury most often feels severe pain or the injury site goes numb.
During the recovery period, not only the bone grows together. Nerve fibers also grow anew towards each other, forming new pathways for the passage of impulses. Within a few months, the body restores all tissues. However, they heal, often forming scars and tears into which nerves grow, making them especially sensitive. Moreover, after a fracture, the main role is played not by the person’s age, but by the duration of the injury - the longer it is, the greater the sensitivity of the nerve fibers.
Moreover, fractures also cause damage to the vessels that are responsible for the capillary blood supply. The flow of blood to the soft tissues will be insufficient even if the blood vessels are narrowed at the fracture site, so people are forced to constantly massage the site of injury in order to compensate for the missing metabolic processes in the tissue cells.
What is an old fracture?
The medical and everyday concepts of an old fracture differ. Traumatologists distinguish three types of fractures according to the statute of limitations:
- fresh (3–4 days);
- stale (from 5 days to 4 weeks);
- old (from a month or more).
Moreover, the time interval here is calculated until the provision of qualified medical care.
However, in everyday speech, we, as a rule, call an old fracture one that was considered already completely healed and left in the past. As a rule, we are talking about injuries that were more than a year old.
In this article, we will allow ourselves to err on the side of medical terminology and will talk specifically about the second option.
Cause of pain from long-standing fractures
So, often where the connections between the nerve processes were disrupted during a fracture, new nerve endings are formed over time, which is felt by increased pain sensitivity. The designation of healthy tissue appears through some structural changes with increased sensitivity to any weather fluctuations and adverse conditions. Such factors may include changes in weather, excessive exercise, or excess weight.
Weather changes
Often people who have broken bones become weather forecasters against their will. Any change in weather causes deterioration in health and pain in a long-damaged limb. Such weather dependence is the norm for old fractures. The fact is that bones and joints are a kind of human internal barometers. Not fully recovered neuron processes that regulate the sensitivity of pain receptors near the damaged bone contribute to increased sensitivity. When humidity increases, when the amount of water in the air increases, or when the air temperature drops, these processes react, causing pain.
Also, pain can be aggravated by vascular pathologies of the extremities, the existence of which many people do not even suspect. After all, sometimes superficial veins can be normal, but internal ones can be blocked. More often than others, smokers suffer from vasoconstriction of the lower extremities, in whom atherosclerotic plaques are deposited on the walls of the arteries. That is why those who have ever broken their legs may experience increased discomfort in the injured limb due to the weather.
Exercise stress
Often old fractures begin to ache after severe stress on the damaged limb. This happens because bone tissue loses a large amount of nutrients after a fracture, and metabolic processes in neurons slow down. These phenomena worsen with age - with senile changes, the bones become thinner, and old injuries begin to hurt more severely. Such pains are called phantom pains because they are not symptoms of any disorders in the body. With such unpleasant sensations, the body simply signals that there is excessive stress on the injured limb.
Overweight
There are cases when, even in the absence of serious physical activity, the damaged bone constantly bothers. There is another factor that directly affects the nerve endings in the tissues near the old fracture - this is an increase in body weight.
Overweight people are particularly susceptible to fractures, especially if they occur in the lower extremities. If a fat person has ever broken a leg, then an increased load will subsequently be placed on the site of the fracture due to its greater weight. This will inevitably lead to pain.
Other reasons
Unfortunately, pain from old fractures is not always so harmless. Doctors say that old injuries in the form of fractures can hurt in the presence of impaired collagen synthesis, leukemia, diseases of the circulatory system, bone tumors, autoimmune diseases, infectious and allergic reactions. In addition, phantom pain can be easily confused with symptomatic manifestations. For example, periodic pain in the hip bones or shoulders, which intensifies after walking or when the weather changes, can be associated not only with old injuries, but also with developing arthrosis of the joints. This disease is chronic and for a long time is expressed only by aches and discomfort. However, if a person does not pay attention to these symptoms, the disease progresses. That is why, if you experience permanent discomfort in places of long-standing fractures, it is better to consult a doctor.
How to avoid problems with old fractures?
Many people live with pain from old fractures for decades. Since discomfort in most cases is episodic and associated with weather conditions, it can be managed with painkillers.
But the risk of re-injury should not be ignored. And if at the age of 20–30 a person can still afford not to think about old damage, then in adulthood one cannot turn a blind eye to this.
So, as we found out, from the point of view of re-fracture, the factor of decreased bone mineral density is of particular danger. Is it possible to influence age-related pathologies of the skeletal system? Yes, there is such a possibility. To do this, we need to have a good understanding of the nature of the metabolic processes occurring in our skeleton.
The most important role in this mechanism is played by the chemical element calcium. It is from it that the mineral structure is formed, which allows us to stand, walk and generally maintain the unchanged shape of the body. Therefore, to strengthen the skeleton, people often take medications with calcium-containing compounds. The most desperate ones even just eat chalk. However, this is not only wrong, but also dangerous.
Firstly, this chemical element is absorbed by the body from different compounds to varying degrees. For calcium carbonate, which is the basis of chalk (as well as 85% of corresponding drugs and food additives), this figure is only 20%, and with low stomach acidity it can drop to zero. For comparison, calcium citrate (a derivative of citric acid) gives us 2.5 times more than carbonate - up to 44%!
Secondly, simply taking calcium is like piling bricks on a construction site and waiting for them to build a house on their own. If the element arrives at the wrong address, it can cause a wide range of diseases:
- when settling on the walls of blood vessels - atherosclerosis;
- when deposited in joints - arthritis and arthrosis;
- with accumulation in internal organs - kidney stones.
Thirdly, bone structure renewal is a complex process in which vitamins D3, B6 and hormones, including testosterone, take part. And while many people have heard more or less about the importance of vitamin D3 (cholecalciferol) for bones, the importance of sex hormones here is shrouded in mystery for most. Although it is hormonal deficiency that is the stumbling block in strengthening the skeleton.
Testosterone, although considered a “male” hormone, is produced in both sexes, and in comparable quantities. Moreover, female hormones - estrogens - are its chemical derivatives. Decreased productivity of the gonads is the main cause of increased bone fragility in older people. How to deceive nature and time? Artificially stabilize hormonal levels. But practice has shown that hormone replacement therapy, based on hormones of synthetic or animal origin, is fraught with numerous side effects, including cancer.
However, Russian scientists have developed an alternative approach - to force the body to reactivate the synthesis of its own testosterone. A special beekeeping product helps to do this, HDBA organic complex, which is a supplier of prohormones - substances that immediately precede testosterone in the process of its chemical synthesis. Thus, it makes this task extremely easy for the body.
Based on this discovery, the drug Osteomed Forte was developed. It includes:
- HDBA organic complex is a donor of prohormones, as well as vitamins, microelements, amino acids and other important chemical compounds;
- calcium citrate is a source of building material for our bones;
- vitamin D3, which maintains calcium homeostasis;
- vitamin B6, which is involved in the production of sex hormones and prevents the deposition of calcium in soft tissues and organs.
Osteomed Forte effectively strengthens bone tissue. A course of taking this drug helps prevent recurrence of injuries at the site of old fractures, and if trouble has already happened, it will shorten the recovery time as much as possible. The innovative vitamin and mineral complex Osteomed Forte is recommended for use as prophylaxis and in complex therapy of osteoporosis and related diseases (arthritis, arthrosis, osteochondrosis, periodontitis).
You can purchase the Osteomed Forte vitamin and mineral complex in pharmacies in your city, as well as in specialized online stores!
First pain relief
How does your leg hurt when you have a broken foot?
We answer. The severity of pain may vary. This depends on the type, severity and number of fractures received.
It is extremely rare that it is weakly expressed. Basically, pain in the leg due to a fracture of the ankle, tarsus and metatarsus is bright, very strong.
For some, they are so unbearable that consciousness becomes clouded, breathing problems develop, and pre-fainting conditions periodically occur. Cases of loss of consciousness due to painful shock cannot be excluded.
Pre-medical anesthesia for injuries and fractures of extremities
After any injury (bruise, ligament rupture, dislocation, fracture), pain should be relieved as quickly as possible. To do this, you need to take 2 tablets of aspirin or, better yet, a loading dose of another non-steroidal anti-inflammatory drug (ketorolac, diclofenac, meloxicam, nimesulide). Children are given ibuprofen tablets or syrup.
After that, a cold compress must be applied to the fracture site. This could be a heating pad or an ice pack.
If you don’t have it, you can take, for example, a bag of frozen vegetables (berries) from the freezer. The instructions for providing first aid warn that “freezing” the injured area should last for 20 minutes, after which a pause for the same amount of time is necessary.
In case of open fractures, you should not refuse their “primary freezing”. After stopping the bleeding and antiseptic treatment of the wound, while the ambulance is on its way, several cold objects should be applied around the injured area.
Attention. In elderly and elderly people, pain after a fracture of the ankle or foot joints can provoke a hypertensive crisis. After an injury, they are recommended to take 2 tablets of Cardiomagnyl or Cardio-aspirin and reduce the pressure with a Captopril tablet (25 mg), placing it under the tongue.
Why do you need cold after injury?
It not only helps reduce pain, but also stops the development of swelling, prevents the spread of a large hematoma, which subsequently allows the doctor to accurately compare bone fragments with the least effort. In addition, it has been noted that ice compresses applied immediately after a fracture allow the formation of a primary callus within the time allotted by nature.
And for those victims who were not provided with such assistance, the process of formation of “primary bone glue” may drag on for 2-4 days.
Period of wearing a plaster cast
After arriving at the hospital, before sending the victim for an x-ray, the doctor must give an anesthetic injection. What specific painkiller will be injected depends on the type and severity of the fracture.
Before repositioning bone fragments manually, anesthesia is usually not repeated. And to install a distraction device or perform an intraosseous osteosynthesis operation, local or general anesthesia will be performed.
Further, pain in the leg after a fracture of the ankle, foot or big toe is relieved within 3-7 days. Usually these are tablets or injections of the non-steroidal anti-inflammatory drugs listed above plus aspirin tablets.
This could be opioids or the non-steroidal anti-inflammatory drugs listed above plus aspirin tablets.
After a week, pain-relieving drug therapy is discontinued. During this time, the inflammatory process subsides, and manifestations of pain serve as a marker for the doctor that something is going wrong in the body.
Preventing the development of edema prevents the onset of pain
Starting from the moment you stop taking pills or injections for pain, you will have to prevent its development with the help of a daily set of exercise therapy exercises for the immobilization period and often lying down with your leg elevated so that the foot is above the knee (pictured above).
On a note. It is recommended to include several isometric exercises for the shoulder girdle and healthy leg into the set of exercise therapy exercises for a fracture in the ankle and/or foot. Such static tension-stretching will help relax muscles that are “clogged” by walking on crutches and get rid of soreness.
Exercise therapy after bone injuries in the area of the foot and ankle should be done within a day after the comparison of bone fragments. Usually they start with a 10-15 minute exercise therapy complex, which needs to be performed 8-10 times a day. Gradually, the time of one lesson increases, and their number per day decreases.
Types of medical treatment for pain in old fractures
There are conservative and surgical types of treatment.
Conservative ones do not involve surgery and are carried out using therapeutic methods. They are performed by an orthopedist-traumatologist. These include:
- drug treatment;
- physiotherapy (manual and hardware methods);
- other methods.
Surgical treatment is usually used in cases where conservative treatments have exhausted themselves and have not brought the desired results. Here, instead of orthopedists, surgeons take on the work. Today the most common methods are:
- metal osteosynthesis;
- endoprosthetics.
If the use of drug treatment and physical therapy does not produce results, a person is forced to endure pain, limit himself in movement, and constantly take painkillers, then a specialist, depending on each individual case, will recommend metal osteosynthesis or joint replacement.
Fortunately, in modern medicine, minimally invasive methods, in which surgical incisions are minimal, are becoming increasingly widespread.