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Why X-rays Get Worse Before They Get Better

Brandt R Gibson, DPM
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Podiatrist, Neuropathy Doctor, Father of 11 and Founder of Mountain West Foot & Ankle Institute
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On my fractured foot (that I injured 11 days ago), I recently took the second x-ray.  This was designed to exhibit the normal healing process of bone.  Bone heals through a very simple process.

  1. Immediately following a fracture, the blood flow is increased to the fracture area and edema (or swelling) is utilized by the body to stabilize the fractured area.
  2. Blood vessels then soon constrict to stop bleeding into the fractured area and the blood cells start to die.  Other cells in the area coagulate to form a soft connection in the area of the fracture.
  3. Damaged tissues are then remodelled, including the resorbtion of the bony ends, causing an x-ray to exhibit more gapping along a fracture line.  This is the reason that a stress fracture is often only visible on plain film x-rays at 10-15 days, when sufficient resorption makes it visible.  Here at Mountain West Foot & Ankle Institute, we commonly see stress fractures much earlier due to the increased visibility, clarity and ability to zoom with digital x-ray technologies.
  4. The soft connection is then replaced with a combination of hyaline cartilage and woven bone.  This forms the fracture callus that increases stability of the fracture and often resolves the pain.  In an unstable fracture, the bone is stabilized by having a very aggressive callus (much thicker than the usual bone).
  5. The hyaline cartilage is then replaced with woven bone to finalize the healing of the bone.
  6. Over time, the bone is remodelled to form trabecular or compact bone.  This creates a complete normal appearance to the bone that precludes us from recognizing where a fracture was after complete healing.

Yes the x-ray looks worse, but that means the fracture is healing.  Isn't the body amazing!

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