Introduction to Trauma and Orthopaedic Scarring
Trauma and orthopaedic scars are a common consequence of serious injury and surgical intervention. While often unavoidable, scars can affect tissue mobility, sensation, comfort and function, particularly when crossing joints or involving underlying soft tissues.
Scars are made of collagen, a natural protein produced by the body to repair damaged tissue. During healing, this collagen is initially laid down in a more disorganised way than normal skin and gradually remodels over time as the scar matures.
Trauma and orthopaedic scars are often the tip of the iceberg, with significant healing occurring beneath the skin as bone, muscle, and other tissues recover from injury and surgery.
The impact of scarring, therefore, extends beyond the skin and may influence movement, strength, dexterity, mobility and participation in daily activities. Recovery therefore, involves adapting not only to the injury itself, but also to the long-term functional and psychosocial effects of scarring.
What do we mean by orthopaedic scarring?
What trauma and orthopaedic injuries are, and how they occur
Trauma and orthopaedic injuries commonly result from road traffic collisions, workplace accidents, sporting injuries, crush injuries, deep lacerations, open fractures and degloving injuries. Initial treatment is directed towards preserving life and limb, restoring circulation and repairing damaged tissues while minimising risk of infection. While scarring is often the last consideration in the acute management, it remains an inevitable consequence of both the injury and the interventions required to restore function.
Trauma and Orthopaedic scars are commonly described as:
Normotrophic scars – scars that mature and typically become and become pale, flat and thin over time.
Hypertrophic scars* – scars that become raised, thickened, yet remain within the boundaries of the original wound and take longer to mature.
Keloid scars* – scars that continue to grow beyond the original wound margins and take longer to mature.
*It is important to note that excessive collagen deposition can occur up to 6 months post trauma, due to the remodelling phase of scarring.
Factors Influencing Scar Remodelling
Several factors can increase the risk of excessive scarring, including delayed wound healing, wound infection, genetic predisposition, individual comorbidities (diabetes, autoimmune conditions), increased tension across a wound, scars crossing joints and extensive soft tissue damage.
One of the largest factors increasing the risk of delayed scar maturation is; reduced understanding of how to manage your scars (from a clinical perspective and from a patient perspective). Early, proactive input can influence how we scar and optimise our outcomes – to get us to maturation quicker and with greater tissue quality and function.
Trauma & Orthopaedic Injuries
Trauma and orthopaedic injuries occur following events such as road traffic collisions, workplace accidents, sporting injuries, falls, crush injuries, deep lacerations, open fractures and degloving injuries. Treatment often involves emergency surgery to repair damaged tissues, stabilise fractures or preserve limb function.
Why Scar Management Often Gets Overlooked
In the immediate aftermath of a serious injury, scarring is rarely the primary concern. The priority is often preserving life, preventing infection, restoring circulation, stabilising fractures and maintaining function. However, scars are an inevitable consequence of both the injury and the treatment required.
What Can You Do for Trauma and Orthopaedic Scars?
The best scar management programme depends on the type of scar you have, the symptoms you are experiencing and the factors contributing to those symptoms. There is no "one-size-fits-all" approach.
First, identify the scar and the symptoms
Before starting treatment, it is important to understand:
When is my scar a scar?
Has the wound fully closed (epithelialised), is it a scar yet? It is important to be very gentle with new scar tissue as it is fragile and at risk of reopening and becoming a wound if too heavily worked on. Section below will highlight importance of timing and what can be done at certain intervals.
What type of scar do you have?
Surgical scars, traumatic scars, skin grafts, flap reconstructions and scars crossing joints may all require different approaches. We have information on different types of scars located on the Scar Therapy Network.
Are there any risk factors for problematic scarring?
Delayed wound healing, infection, skin grafts, repeated tension, multiple surgeries and previous raised scarring can all influence scar behaviour.
What symptoms are you experiencing?
Effective scar management aims to address the underlying cause of symptoms, not just the appearance of the scar.
Common symptoms and treatments
• Itching – Often associated with dry, immature scars. Medical moisturisers and silicone products can help improve hydration and reduce irritation.
• Tightness – May occur when scars are repeatedly stretched during movement or cross a joint. Scar massage, movement exercises, tension-shielding techniques and silicone therapy may help.
• Raised or thickened scars – Compression garments, silicone therapy and specialist scar treatments may help regulate collagen production and flatten raised areas.
• Pain or tenderness – Can result from sensitivity, tension within the scar or deeper tissue restrictions. Massage, desensitisation techniques and specialist therapies may be beneficial.
• Changes in sensation – Numbness, tingling or hypersensitivity may respond to sensory re-education and sensory re-mapping programmes.
What you can do at home
• Moisturise – Apply a fragrance-free moisturiser at least twice daily to maintain skin hydration and reduce dryness, itching and discomfort.
• Silicone products – Silicone gels, sheets or sprays may help improve scar appearance, texture and hydration.
• Massage – Regular scar massage can help soften tissue, improve mobility and reduce feelings of tightness.
• Movement and stretches – Regular movement is particularly important when scars cross joints, helping to maintain flexibility and function.
• Protect from sunlight – Scars are more vulnerable to sun damage and pigmentation changes. Use sun protection and cover scars where possible.
Treatments that may require specialist input
Compression garments
Custom-made garments may be prescribed to help flatten raised scars, reduce symptoms and support scar maturation
Negative pressure therapy
Negative pressure therapy gently lifts and mobilises scar tissue to improve pliability, reduce adhesions and support fluid movement within the surrounding tissues.
Silicone elastomers
Custom silicone inserts can be used alongside compression to target specific raised or irregular scars.
Sensory re-education
Structured programmes may help address altered sensation, hypersensitivity and discomfort.
Skin camouflage
Specialist colour-matched products can help reduce the visual impact of scarring where appropriate.
The most effective scar management programmes are usually tailored to the individual, targeting the specific symptoms and challenges that matter most to them.
Recovery Timeline Following Trauma and Orthopaedic Scarring
Recovery following trauma or orthopaedic surgery is different for everyone. The timeline below provides a general guide to how scars may develop following fractures, surgical fixation, joint replacement, tendon repair, skin grafting, flap reconstruction or other traumatic injuries.
It is important to remember that scar maturation is influenced by many factors including age, overall health, smoking status, diabetes, wound complications, infection, scar location, injury severity and individual genetics. As a result, these timelines should be viewed as a guide rather than a strict definition of recovery.
Whilst scar tissue becomes progressively stronger over time, it never fully regains the same properties as uninjured skin and soft tissue.
What Happens in Orthopaedic Surgery as a Result of Trauma?
What to Expect 0–2 Weeks after Surgery
Immediately following injury or surgery, the body's priority is protecting the wound and initiating healing. Swelling, bruising, discomfort and reduced movement are common during this phase.
The wound is held together primarily by sutures, staples or surgical fixation rather than the strength of the healing tissue itself. At this stage, the scar has very little tensile strength and is vulnerable to excessive tension. These may be removed 10 – 14 days after surgery.
Treatment during this phase typically focuses on:
• Wound protection and monitoring for infection
• Swelling management
• Pain control
• Maintaining function in surrounding joints and tissues
What to Expect 2-6 Weeks after Surgery
As the wound closes, early scar tissue begins to form. Collagen is rapidly produced to bridge the injured area, although the fibres remain relatively disorganised and immature.
You may begin to notice:
• Redness or pinkness (vascularity) around and on the scar
• Increased sensitivity or tenderness
• Early tightness during movement
• Itching as healing progresses
Although the wound may appear healed externally, the underlying tissues remain relatively weak and continue to remodel beneath the surface.
Treatment may include:
• Medical Moisturising Retention Creams
• Silicone therapy
• Gentle scar massage over and around the scar, using a medical moisturiser
• Range of movement exercises
• Early desensitisation techniques (Sensory re-education)
• Compression therapy where indicated
What to Expect 6-12 Weeks after Surgery
The scar enters a more active remodelling phase. Collagen continues to be produced and reorganised in response to movement and mechanical forces.
Many trauma and orthopaedic scars begin
to demonstrate:
• Increased tightness around joints
• Raised or thickened areas
• Ongoing redness or vascularity
• Changes in sensation such as numbness, tingling or hypersensitivity
By approximately three months, the scar has gained a significant proportion of its eventual strength, although it remains weaker and less adaptable than uninjured tissue.
This is often when structured scar management becomes particularly valuable.
Treatment may include:
• Scar massage
• Silicone products
• Stretching and rehabilitation exercises
• Specialist scar assessment
What to Expect 3-6 Months after Surgery
The scar continues to mature and adapt to the demands placed upon it. Many people notice gradual improvements in colour, texture and mobility.
Common changes include:
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Reduced redness
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Improved scar mobility
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Less itching and discomfort
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Gradual return of sensation
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Improved confidence using the affected limb
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For scars crossing joints or involving deeper structures such as tendons, muscles, nerves or fractures, ongoing rehabilitation remains important to minimise stiffness and optimise function.
Specialist treatments such as compression garments, silicone elastomers or negative pressure therapy may continue to provide benefit during this stage.
What to Expect 6-12 Months after Surgery
Remodelling continues, although changes often occur more gradually than during the earlier phases of healing.
Many scars become:
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Softer
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Flatter
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More flexible
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Less symptomatic
However, it is important to recognise that inflammation can persist beyond the first year following injury or surgery. Ongoing redness, sensitivity, itching, raised tissue or discomfort may indicate that the scar remains biologically active and continues to remodel.
This is particularly common following:
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Severe trauma
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Multiple surgical procedures
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Delayed wound healing
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Skin grafts and flap reconstruction
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Scars exposed to repeated tension or movement
Where inflammation remains present, scars may continue to change and respond to treatment long after the first year of recovery.
What to Expect 12+ Months after Surgery
Scar maturation does not stop at a specific time point. Whilst many scars have undergone significant remodelling by 12 months, others may continue to evolve for considerably longer depending on the individual and the nature of the injury.
Changes in colour, texture, mobility, sensation and symptoms can continue as long as low-level inflammation and tissue remodelling remain present.
For some individuals, scar management may no longer be necessary. For others, ongoing interventions such as moisturising, massage, silicone therapy, compression or specialist treatments may continue to provide meaningful benefit.
A Note on Tensile Strength
Although scars become progressively stronger over time, healing is not always reflected by appearance alone.
A scar that looks mature on the surface may still be remodelling beneath the skin. Equally, a scar that remains red or noticeable may still be progressing normally.
As a general guide:
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Scar tissue has very little strength during the first few weeks after injury or surgery.
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Tensile strength gradually increases as collagen fibres reorganise and mature.
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Most gains in strength occur during the first year following injury.
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Even a mature scar typically achieves around 70–80% of the tensile strength of uninjured skin.
This is why ongoing scar care, rehabilitation and movement can remain valuable long after the wound itself has healed.
Remember: recovery is highly individual. These timelines are intended as a guide only and should always be considered alongside your own symptoms, goals, medical history and healing journey.
Products That Can Help Your Scar Recovery
