How can significant injuries like broken bones be healed?

Question

During a campaign I ran several years ago, one player's character suffered nonlethal damage during a sparring session and broke his arm. When he healed the damage naturally overnight, he argued that his broken arm should have been healed as well. I ruled that he would have to wait several weeks for the arm to heal on its own, despite not having nonlethal damage.

But would he actually have to have waited?

I am specifically looking for ways in which the rules as written in the core handbooks can be leveraged to allow significant injuries, such as broken bones, to heal.

I don't consider natural healing likely to heal broken bones overnight, but what about cure spells/potions? According to the Player's Handbook, page 215, cure light wounds allows the caster to "channel positive energy that cures 1d8 points of damage +1 point per caster level."

What are the logical limits of healing/curing damage, by magical or mundane means, as applied to significant injuries? Do things caused by damage go away when the damage goes away?

Answer 1

Real-world-damage is classified in several different ways in D&D 3.5

Hit point damage

What are hit points? Hit points are your capability to not take the fatal blow, but are also how wounded you are.
Are these two definitions a dycothomy? Well, as with every abstraction I'm prone say yes.

Poisons that only get applied by harming you enemy and drawing blood need HP damage to be dealt. At the same time most other mechanics work really well by comparing HP with how much stamina you still have - when you have none, you can't parry properly and you're k.o.

Cure spells and potions do just what natural healing does, just faster: it restores HP. (Maybe with less scars, maybe with more, who knows?)

Ability damage

This recovers really slowly over days of complete rest (or with specific magic) and I'd go with this to represent having a limb broken, except it isn't specific to a location.

Limb severing

While the game states no in-combat way to have a limb severed, several spells consider the opportunity. Polymorph efefcts have severed limbs take their former form or not depending on which kind of spell or ability you have been using and regeneration (a 9th level spell) is the only way to restore a lost limb save a miracle or some shenanigans involving different spells.
Losing a limb is pretty definitive and shouldn't happen during a combat.

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So, breaking an arm does not look like an option.

What would have been the rules-friendly way to handle this? Well, not ruling a broken arm in the first place, and settling for a more temporary form of nonlethal damage, like straining a muscle. Nothing in the grapple rules allows you to disable your opponent that badly. Again, this is a problem that lies in how D&D abstracts this specific thing, and D&D is all about "no consequences until you get to 0 hp and then the only consequence is that you stagger/faint or what have you (a limited list of outcomes that does not match with reality).

Since the D&D rules work like a physics simulator that uses its own unfamiliar phisics, it sure breaks our expectations, but IMO it's better to break immersion where the rules say than having to face unstated consequences like having to decide how inconvenient it is to lose a brawl after it has happened, because the unpredictability of consequences destroys the risk assessment capabilities of the players and makes them unable to make informed decisions.

Answer 2

Rules as written, there are no injuries like this. Literally nothing in the rules inflicts them, the rules don’t specify what effects they have on your stats or abilities, and so on.

Injury is entirely abstracted to the realm of HP damage, and to a lesser extent, ability score damage.

There are two references to the concept in the rules: regenerate, and the ring thereof. Regenerate can clearly fix a broken arm; it can re-grow an arm that has been entirely destroyed. (The ring can fix such injuries, but only if it was worn when the injury took place.) Presumably, re-attaching a severed arm is easier than recreating one from scratch, and certainly, healing a broken arm is much easier still seeing as that can be done in real life. This does suggest that there should be something less powerful than regenerate for healing such injuries, including a natural-healing option for broken arms.

But because the rules do not include these injuries as potential conditions for a character to suffer from, they also do not in any way address how they might be healed. The fact that regenerate references lost limbs is, itself, kind of out of place, since it effectively talks about healing injuries that the rules do not suggest can take place.

So from a rules-as-written perspective, these injuries don’t happen. Equally, from a rules-as-written perspective, how they are healed is effectively an invalid question: the rules cannot address a circumstance that the rules do not suggest can happen in the first place.

As such, any inclusion of significant injuries beyond these sorts of damage is entirely houserule, and when creating such a houserule the DM is responsible for detailing how these things happen, how they affect the patient, and how they can be healed. Ideally, these sorts of houserules are drawn up ahead of time and shared with the group, so that they know when they are at risk of such things, what the consequences are, and how to handle them when they do happen. (And you can also get into things like skill checks necessary to recognize such injuries, protect against them, help limit the damage done, help the healing process, and so on.)

Answer 3

Your question stems from the fact that you seem to conflate two different issues: the amount of HP the character has and bodily trauma he suffers.

HP models the character's ability to avoid harm

So in fact a character with 1 HP could be almost unharmed, but be tired enough so that the next attack that hits will injure and take him out.

Bodily trauma is represented by non-combat consequences

Your character breaking an arm is a consequence that he has to accept for success, a cost that he pays to live a life of adventure. It does not heal overnight, it heals when it's healed or when it's no longer relevant, important or interesting.

Long-lasting injuries are plot devices, not part of combat mechanics

Now, that's theory. You ask whether your ruling makes sense. I say: you had two completely different viewpoints. Player assumed HPs are tied to injuries, you didn't. You are right that sleeping a broken arm off breaks verisimilitude, but the player is right, that he should have healed the damage dealt.

To make the injury interesting without contradicting the game rules, I'd say the character has full HP, the arm is still broken. Then you, as a GM, consider what is more interesting and exciting for the player: dealing with a broken arm consequences or continuing as if nothing has happened?

If it's the first, you tell him he has to put it in a cast and wait for it to mend or seek a healer. You turn your broken arm plot device into a sidequest, his HP still begin the maximum as if the arm was fine. He suffers consequences of the break, e.g. can't use a shield, gets a penalty to Dex or something of that kind.

If it's the second, you tell him he puts the arm in a cast and applies some potions and the arm fixes itself quickly, without bothering him in combat at all. Again, his HP heals as if the broken arm was not there.

Answer 4

Some Ambush Feats cause "significant injuries" apart from ability damage - though no broken bones

"Hamstring" is descripted as damaging the legs and reduces the opponents speed by half, forgoing 2d6 of sneak damage.

This speed reduction ends after 24 hours have passed or a successful DC 15 heal check or the application of any cure spell or other magical healing is made. Complete Warrior, p. 100

The same rule aplies to damge caused by caltrops:

If the caltrops succeed on the attack, the creature has stepped on one. The caltrop deals 1 point of damage, and the creature’s speed is reduced by one-half because its foot is wounded. This movement penalty lasts for 24 hours, or until the creature is successfully treated with a DC 15 Heal check, or until it receives at least 1 point of magical curing. PHB, p.126

The same healing rule applies to the ambush feat Arterial Strike (bleeding wound).

Other effects caused by Ambush Feats are only temporary, especially "Lacerate" (DR 344) which causes one hand do be useless for 10 rounds/1 minute. The same is true for the ability damage caused by "Concussion Attack", "Impeding Attack" or "Painful strike".

These rules clearly show, that hampering injuries should be temporary or easy to cure. Deducting from the rules above, I would judge:

Broken arms are not RAW, but hampering injuries should be removed automatically within 24 hours, by a DC 15 heal check or by the application of any cure spell or magical healing.