Fractures and Physiology: The Science Behind Healing Bones in Youth and Adulthood

Abstract

The tibia and fibula, the weight-bearing bones in the leg, can sustain many different types of fractures that disrupt mobility and sport participation, with healing and management differing substantially by age. This narrative literature review synthesized peer-reviewed studies identified via PubMed, Google Scholar, and the Katz Library to compare anatomy, epidemiology, healing biology, treatment outcomes, and return to activity in children versus adults. Across the sources, children demonstrated shorter times to union - often 4-12 weeks - depending on fracture pattern (stress, direct, or indirect fracture) and location (distal, proximal, or tibial shaft), and greater remodeling capacity due to open growth plates and a thicker periosteum. This enables children and adolescents to expand their horizon in the field of treatment options, allowing casting to be an effective treatment for them, whereas adults commonly rely on surgical fixation. Adults showed substantially longer healing rates, often between 14-24 weeks with a higher risk of delayed/nonunion, which further complicates the healing process. Incidence patterns varied by site (proximal in older adults, tibial shaft in adolescent males, and distal in young adults). The rate of return to sport was more frequent in children (between 4-6 months; >90% of children) than adults (between 6-9 months; ~75% of adults). These conclusions support age-tailored treatment, differentiating prevention and rehabilitation strategies to optimize healing timelines.