What are Nonhealing Fractures/Nonunion?
A fracture is a break in the bone that occurs when extreme force is applied. Treatment of fractures involves joining the broken bones back together either by immobilizing the area and allowing the bone to heal on its own, or surgically aligning the broken bone and stabilizing it with metal pins, rods, or plates. Sometimes, the broken bone fails to rejoin and heal even after treatment. This is called a nonunion or nonhealing fracture.
Causes of Nonhealing Fractures/Nonunion
Nonhealing fractures/nonunion occurs when the broken bones do not get sufficient nutrition, blood supply, or adequate stability (not immobilized enough) to heal. Cases of fracture nonunion are also more likely if the bone cracks from a high-energy injury, such as from a motor vehicle collision, as severe injuries often impede adequate blood supply to the fractured bone.
Risk factors of nonunion include:
- Smoking or tobacco use
- Older age
- Severe anemia
- Prolonged use of medications such as NSAIDs (nonsteroidal anti-inflammatory drugs)
- Poor diet with low proteins and vitamins
Controlling risk factors can prevent the chance of developing a nonunion.
Signs and Symptoms of Nonhealing Fractures/Nonunion
A nonhealing fracture or nonunion can be identified by pain at the fracture site after the initial pain has subsided or disappeared. The pain may be chronic or persistent, lasting months or even years, or may come about only when the fractured limb is used. Other symptoms include swelling, tenderness, deformity, and difficulty bearing weight.
Diagnosis of Nonhealing Fractures/Nonunion
Your physician diagnoses nonunion based on the findings such as pain at the surgical site, persistent gap with no bone over the surgical site, or inadequate or no progress in bone healing despite providing sufficient time to heal. Your physician confirms the diagnosis of nonunion using imaging studies such as X-ray, CT (computed tomography) scans, and MRI (magnetic resonance imaging) that provide detailed pictures of the bone and surrounding soft tissues. Blood tests may also be ordered to determine the cause of nonunion, such as diabetes, infection, or other conditions that may slow bone healing.
Treatment for Nonhealing Fractures/Nonunion
The treatment of nonunion fractures can be achieved by both non-surgical or surgical procedures.
The most common non-surgical treatment involves the use of a bone stimulator, a small device that produces ultrasonic or pulsed electromagnetic waves, which stimulates the healing process. You will be instructed to place the stimulator over the region of nonunion for 20 minutes to a few hours every day for the best results.
The surgical method of treatment for nonunion is aimed at:
- Stimulating a new healing response: Bone grafts may be used to provide fresh bone-forming cells and supportive cells to stimulate bone healing.
- Providing a healthy blood supply and soft tissue at the fracture site: Your doctor removes dead bone along with any poorly vascularized or scarred tissue from the site of the fracture to encourage healing. Sometimes, healthy soft tissue along with its underlying blood vessels may be removed from another part of your body and transplanted at the fracture site to promote healing.
- Establishing stability: Metal rods, plates, or screws are implanted to hold the broken bones above and below the fracture site. Support may be provided internally or externally.