Bone needs multiple factors to heal. Regardless of whether a surgeon recommends conservative vs surgical care – the external environment needs to be optimized to achieve satisfactory healing in a timely manner. We always check vitamin D levels on patients that have a fractured bone, or are undergoing bone surgery of any kind. Some doctors may feel this is unnecessary, but our perspective is that Vitamin D has been proven to be absolutely vital for bony healing in countless studies. It is not an expensive test. Vitamin D is vital for many important processes in the human body. We have found through studies that a level of at least 50 is ideal for healing. The “normal range” is from 30-100.
Another factor that allows bone to heal properly is immobilization. Bone heals ideally in a “quiet” or “still” environment. Excessive motion prevents bone cells (osteoblasts) from doing their job properly. When surgery is utilized it is important the surgeon use hardware effectively to control motion on the “inside”, but afterwards it is then incumbent on the patient to control the motion on the “outside’. When patients walk excessively after surgery, and are not totally compliant with their directions their ability to heal is jeopardized substantially.
Smoking is a huge risk factor when discussing bone healing. Smoking tobacco releases known toxins that will substantially limit the body’s ability to heal itself. Approximately 7,000 toxins according to the CDC, 2010. It has been hypothesized that smoking may slow healing in foot and ankle surgery by up to 42%. The significance of this simply cannot be understated.
Lastly, an important tool often utilized to try and hasten/complete bone healing is referred to as a bone stimulator. These devices are covered by insurance only when certain milestones in the healing process have not been reached. Medically these terms are “delayed union” (if not healed by 3 months), and “non-union” (if not healed by 6 months). Insurance will not typically pay for this device prophylactically, unfortunately.