Most fractures are treated by realigning the broken bone, holding it still long enough to heal, and gradually restoring movement and strength. The specific approach depends on which bone broke, how badly it shifted, and whether the surrounding soft tissue is damaged. Simple fractures often heal in a cast over several weeks, while complex breaks may need surgery with metal hardware to hold the pieces together.
How Bones Heal on Their Own
Understanding what your body does after a fracture helps explain why each treatment step matters. Bone healing happens in four overlapping stages, and every treatment decision is designed to support this natural process.
Immediately after the break, blood pools around the fracture site and forms a clot. This triggers inflammation that brings in cells to clean up damaged tissue. Within about two weeks, your body lays down a soft, rubbery bridge of cartilage-like tissue between the broken ends. Over the following weeks, that soft bridge gradually hardens into a bony callus made of immature bone. This new bone is thicker and lumpier than the original, but it’s strong enough to bear some load. The final stage, remodeling, can continue for months to years. During this phase, your body slowly reshapes that rough patch of new bone until it closely resembles the original structure.
Every treatment choice, from how the bone is aligned to how long you stay in a cast, is timed around these stages. Disrupting any one of them (by moving the bone too early or restricting blood flow) can slow or stall healing.
Realigning the Bone
If a fracture has shifted out of position, the pieces need to be lined up before healing begins. This step is called reduction, and there are two main ways to do it.
Closed reduction means a doctor manipulates the bone back into place from the outside, without making an incision. You’ll typically receive local anesthesia or sedation. A clamp or manual pressure guides the fragments into alignment, and the position is confirmed on X-ray. This works well for simple fracture patterns where the bone has broken into just two or a few large pieces.
Open reduction requires surgery. The surgeon makes an incision, directly visualizes the fracture, clears out debris, and lines up the fragments before securing them with hardware. Fractures that are shattered into multiple small pieces (comminuted fractures) are more likely to need open reduction because there’s no way to accurately reposition all those fragments from the outside.
Holding the Bone Still: Casts and Splints
Once a bone is aligned, it needs to stay that way. For fractures that are stable, or after a successful closed reduction, a cast or splint is usually enough.
Plaster casts are inexpensive, easy to mold to the shape of your limb, and can be adjusted while they set. The tradeoff is weight: plaster is noticeably heavy, doesn’t breathe well, and falls apart if it gets wet. It also loses holding strength with repeated stress. If the cast flexes beyond a certain point, its ability to support the bone drops significantly on the next cycle of movement.
Fiberglass casts, introduced in the 1970s, are roughly five to six times stronger than plaster under tension and about three times stronger under bending force. They’re lighter, more durable, and resist water much better. Both materials still share some downsides: skin underneath can get itchy and irritated, and your doctor can’t directly examine the soft tissue beneath the cast without removing it.
Splints are often used as the first step, especially when swelling is expected. They wrap partway around the limb and leave room for the tissue to swell without cutting off circulation. Once swelling goes down, a full cast may replace the splint.
When Surgery Is Needed
Some fractures can’t heal properly in a cast alone. Bones that are badly displaced, shattered, or located in areas where precise alignment matters (like joints) typically require surgical fixation.
Internal Fixation
This is the most common surgical approach. After opening the skin to see the fracture, the surgeon secures the bone fragments with metal plates, screws, rods, or wire. The hardware stays inside your body and holds everything in place while healing progresses. Internal fixation restores the bone’s anatomy precisely, but the surgery itself involves cutting through soft tissue, which adds its own recovery time. There’s also a slightly higher risk of infection around the hardware, and some patients eventually need a second procedure to have metal removed if it causes irritation.
External Fixation
In this approach, metal pins or wires are inserted through the skin into the bone above and below the fracture, then connected to a rigid frame outside the body. External fixation causes less damage to the surrounding soft tissue, which makes it a good choice when the skin and muscle around the fracture are badly injured, burned, or swollen. Ring-style external fixators (sometimes called Ilizarov frames) may even promote faster bone union in certain fractures. The downside is that pins sticking out of the skin require careful cleaning to prevent infection, and the frame can be cumbersome to live with for weeks or months.
Managing Pain During Recovery
Fracture pain is sharpest in the first few days and gradually eases as the initial inflammation settles. A layered approach to pain relief works better than relying on a single medication.
For mild pain, acetaminophen (paracetamol) alone is usually sufficient. Moderate pain is typically managed with acetaminophen plus a mild opioid like codeine. Severe pain, especially right after the injury or surgery, may require stronger pain relief administered in a hospital setting and carefully adjusted to your response.
Anti-inflammatory medications like ibuprofen can supplement pain relief, but they come with a caveat: there’s an unresolved concern that they may interfere with bone healing. Clinical guidelines from the UK’s National Institute for Health and Care Excellence recommend against giving anti-inflammatories to older or frail adults with fractures and suggest using them only as a supplement, not a first-line choice, in younger adults. Interestingly, for children with limb fractures, ibuprofen is considered a reasonable first option because it offers a better balance of pain relief and side effects than the alternatives at that age.
Weight Bearing and Rehabilitation
After a lower-body fracture, your surgeon will prescribe a specific weight-bearing level that progresses as healing advances. Getting this right is critical: too much load too early can shift the bone, but too little activity for too long weakens muscles and stiffens joints.
- Non-weight bearing: Your injured leg does not touch the floor at all. You rely entirely on crutches or a walker, using only your uninjured leg.
- Touch-down weight bearing: Your toes can rest on the floor for balance, but you don’t push any actual weight through the leg.
- Partial weight bearing: You gradually increase the load on the injured leg, often guided by a percentage of your body weight.
- Full weight bearing: The leg can support your entire body weight, and you can walk without assistive devices.
The timeline for moving through these stages depends on the bone, the type of fracture, and how surgery went. Your physical therapist will work on range of motion, strength, and balance at each stage. Upper-body fractures follow a similar progression: initial immobilization, gentle range-of-motion exercises once the bone is stable enough, then strengthening.
What Slows Healing Down
Most fractures heal within the expected window, but certain factors raise the risk of delayed healing or nonunion (where the bone fails to bridge the gap entirely). Smoking is the single most well-documented lifestyle risk factor. A large meta-analysis found that smokers have 2.2 times the risk of delayed union or nonunion compared to nonsmokers. That elevated risk held across every subgroup studied, never dropping below 1.6 times the nonsmoker rate. If you smoke and break a bone, quitting or at least stopping during recovery meaningfully improves your odds.
Other factors that slow healing include poor blood supply to the fracture site, diabetes, infection, inadequate nutrition (especially low calcium, vitamin D, and protein intake), and excessive movement at the fracture before the bone has solidified.
Bone Growth Stimulators for Stubborn Fractures
When a fracture isn’t healing on schedule, your doctor may recommend a bone growth stimulator. These devices deliver low-level electrical energy or pulsed electromagnetic fields to the fracture site, either through pads placed on the skin or through implanted electrodes. The goal is to kickstart the stalled biological process of bone formation.
A meta-analysis of 15 randomized controlled trials found that electrical stimulation reduced the rate of nonunion by 35%. Put another way, for every 7 patients treated with a stimulator, 1 nonunion was prevented. These devices are typically reserved for fractures that have shown no healing progress after several months, or for patients with known risk factors for nonunion. They’re not a routine part of fracture care, but they offer a meaningful option when standard treatment stalls.