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Fracture Care

Nonunion Fracture

Most fractures will heal well with conservative treatment in about 8 – 12 weeks. In 5-10% of people with a broken bone the fracture fails to properly heal. Healing a broken bone is a complex process that involves re-uniting disrupted bone caused by a break. Nonunion fractures cause prolonged pain and disability that can have a significant impact on quality of life.

A nonunion means there is no indication of healing for at least 3 months from the date of the fracture; and bone healing has stopped and will not proceed without intervention. A delayed union is where a fracture takes too long to heal. A malunion means the fracture healed but the bones are not properly aligned which can impair function. Nonunions and malunions are common in long bone fractures of the forearm, the elbow, thigh bone, the upper arm bone, and the collar bone. Nonunions and malunions are also found in finger, ankle, and foot fractures.

Many external factors are involved in healing a fracture. The location and severity of the fracture are two very important factors that influence time to union. The most important factor affecting bone healing is the energy of the injury causing the fracture and the associated soft tissue injury. Low energy fractures tend to heal faster than high energy fractures of the long bones. Open injuries with soft tissue damage have a high risk of infection and poor healing.

Nonunion causes considerable pain at the site of the fracture that can last for months or years unless treated. The pain may only be felt when the broken bone is used, or all the time regardless of activity. Risk factors depend on the specific fracture, the severity of the injury, infections, and a patient’s comorbidities and medications.  Importantly, healing requires a good blood supply.  In some cases, the injured bone naturally has only a limited blood supply, or there was injury that caused the break also damaged to the blood vessels, as well as muscles and skin.

For bones to heal well they need to be stabilized and have a good blood supply. First the broken bones must be aligned and then stabilized to hold them in place while the break heals. Stability can be achieved with a splint or cast. Sometimes, surgery is needed realign the broken pieces and stabilize the bones with screws, nails, and plates.

A good blood supply is essential since the blood carries the necessary nutrients, oxygen and growth factors that support healing. The blood supply may have been damaged during the accident or injury that caused the break. Bone cannot heal without a good blood supply.

A nonunion of a bone fracture occurs when there is inadequate stability or blood flow or both. Most often the cause of nonunion is multifactorial including patient factors and injury factors.

Risk factors that impair bone healing include:

  • Smoking
  • Any tobacco use
  • Alcohol use
  • Age
  • Anemia
  • Diabetes
  • Hypothyroidism
  • Poor nutrition
  • Medications like anti-inflammatories like aspirin, ibuprofen, and prednisone.

Your OANC specialist will use imaging studies to identify the bones and soft tissues including X-rays, CT scans and MRIs. They will also ask about your symptoms and the history of your break. Successful management often requires assessment and treatment of patient factors including coexisting conditions like diabetes. That is why our specialist will likely order blood tests to test for infection and diseases that can interfere with bone healing.

The majority of nonunions can be managed effectively with conventional surgical procedures.

There are a range of nonsurgical treatments, including casting. Other treatments such as ultrasound stimulation or electrical stimulation can help to improve healing in people with slowed healing due to aging and disease. If the nonunion is also out of alignment, surgery will be necessary to realign and stabilize the bones so that they can heal together. This may include bone grafts as well as internal hardware to hold the bones together.

At the Center for Orthopedic Specialists treatments for nonunions are always tailored to each patient’s needs. Contact us to schedule a consultation today. We have offices in Mission Hills, Tarzana, West Hills and Westlake Village for your convenience.

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