all goes well the bone unites and stops hurting, the soft tissue forms
scar tissue which binds the injured parts together and restores function;
finally the tissue remodels to transform into something very close to
the original tissue. The normally painful parts of this process are
the acute pain of the injury (hours), the post treatment pain from surgery
or manipulation (days), the pain from the swelling and inflammatory
phase of healing (weeks) and the aching from the re-building, remodeling
phase (months). These pains are an inevitable consequence of the injury.
The rest of this section deals with pain that is not inevitable and
which may be a sign of trouble. The medical term for these processes
is "complications" - which is more self explanatory than most
jargon. Although there is some overlap,
I have divided these subjects into early, medium term, recurring, and
late pain, and painful fixation.
A word of warning.
This account is for general knowledge and information. It is not for self-diagnosis.
Most of these complications are rare. If your leg hurts for a time after
a fracture most likely this is normal - ask anyone on the dicussion board!
Do not use this account as a "shopping list" of problems and
symptoms. You would do yourself a disservice, irritate and deceive your
OS and diminish the value of the whole effort. Absolutely the last things
you need are an increase in anxiety or treatment for a problem that doesn't
exist; so please be careful in taking these accounts personally. These complications are rare. Less that 5% of patients with a broken leg will experience symptoms from any of these conditions. Each
topic will be treated in depth in a separate page. This page treats the
topics very briefly.
Early Painful Complications
These are problems
that may occur to increase pain within days of the injury and its treatment.
Since the leg is expected to hurt during that stage these problems may
not be easy to diagnose.
The pressure in the tissue compartments rises to the point where circulation
to the muscles is compromised.
Acute infection occurs when pathogenic bacteria become established and
grow in the wound or fracture site
Loss of fixation or position
If the fracture fragments are still mobile the fracture will be unusually
Damage to nerve trunks or pressure on nerves will cause a burning pain
and numbness or pins and needles sensation. Vascular injury may cause
pain and numbness of the extremity.
Dressings or casts which dig into the leg may cause pain.
Deep Vein Thrombosis (DVT)
Blood clots forming inside veins may produce painful thrombo-phlebitis
(translation: inflammation of the veins due to blood clotting)
Medium Term Painful
These conditions must
be considered if the "normal" pain that occurs with a fracture
continues into the 3rd or 4th week post injury.
Unresolved deep infections caused by bacteria are painful and often
also cause redness, tenderness and swelling of the region and the wound.
Although blood clots form at the time of the injury they may not
produce symptoms of pain until later
Reflex Sympathetic Dystrophy (RSD)
This problem is a disturbance of the control of blood supply to
an injured region. Normally there is a (reflex) increase in blood supply
following the injury. As the inflammation settles the blood supply decreases.
For some reason this decrease fails to occur in some people and the
blood supply remains increased for many weeks. The result is throbbing,
pain and stiffness.
Injury or pressure on a nerve causes a characteristic burning aching
pain, often accompanied by sensitivity in the area of distribution of
A fracture which is not uniting may still be mobile and painful
Failure of Fixation
If the hardware is not strong enough for the stresses placed on
the leg it will bend or break or
the screws will pull out. If fixation is lost in this way the fracture
will be mobile and painful again.
If a healing fracture
is re-injured it will be painful again.
In some situations
the leg becomes painful again after a relatively pain free period.
Indolent or non virulent infections can smolder on for a long time
with minimal symptoms then flare up.
A fracture which has failed to unite is most often painful.
Chronic Compartment Syndrome
Sometimes after injuries the muscles swell when you exercise and
cause pain. This occurs quite late because you aren't able to exercise
the muscles until the bone is well healed.
Late Painful Complications
infection is persistently painful
compartment syndrome results in scarring and contracture of the affected
muscle which usually causes long term pain.
which has failed to unite is most often painful.
Post Traumatic Arthritis
joint surface adjacent to the fracture was injured and rough as a result,
the joint will wear down, causing painful post traumatic arthritis.
This is a very common late complication of intra-articular fractures,
particularly of the knee and ankle.
Reflex Sympathetic Dystrophy is a rare but serious cause of long term
pain after injury
If joints fail to
recover normal movement they may become painful or they may place stress
on the next joint up and make that painful.
of the Hip
some types of hip fracture a small percentage lose the blood supply
to the femoral head. Even if the fracture heals the dead bone may cause
a long term problem with pain and arthritis. A similar problem can occur with fractures of the talus.