Nonunion Fractures Treatment
A nonunion can occur due to multiple factors, one of which is the detachment of the fractured bone ends from the blood vessels that nourish them. This detachment causes the bone ends to wither away, making it difficult for them to contribute to the healing process, resulting in a higher chance of nonunion. The absence of proper blood supply and growth of new blood vessels prevents new bone formation and impedes the healing of the fracture.
Nonunion Vs. Delayed Fractures
Most broken bones can be treated effectively with modern methods, and typically heal without complications. After treatment, it usually takes a few months for new bone tissue to grow and connect the broken pieces. However, in rare cases, the broken bone may not heal properly even with treatment, and this is called a nonunion fracture. It’s important to note that delayed union is a different condition where the fractured bone takes longer than usual to heal.
The issue of nonunion in orthopedics is not straightforward, and treating clinicians must consider various approaches to address the situation. In order to determine if the fracture has healed, x-rays must be examined to see if the cortical bone has grown over the break. Additionally, doctors must assess whether the patient is experiencing pain while putting weight on the affected area, and if there is no movement at the fracture site. Other medical conditions the patient may have must also be considered to identify any risks that could hinder bone healing. To promote the healing of the fracture, clinicians must optimize these factors.
Nonunion Fractures Causes
Several factors can contribute to a fracture failing to heal properly. It’s crucial for your orthopedic doctor to take these into account since addressing them is critical in deciding the appropriate course of treatment. Causes of non-healing or non-union fractures include insufficient blood flow to the bone, infection occurring at the fracture site, separation of the bone ends (either during or after surgery), and inadequate surgical stabilization of the bone.
Symptoms of nonunion fractures
Nonunion factors are associated with these symptoms:
- Difficulty bearing weight
- Deformity
- Tenderness
- Pain
- Swelling
What are the risk factors for nonunion fractures?
The following factors increases the risk of nonunion:
- A complicated break that is open or compound
- A complex, open or compound fracture
- Infections
- Hypothyroidism (metabolic factor)
- Low vitamin D levels
- Low bone mineral density
- Genetic predisposition
- Diabetes
- Severe Anemia
- Poor nutrition
- Old age
- Smoking and use of tobacco products
- Alcohol consumption
Treatment
The approach to treating nonunions is individualized for each patient, with the doctor first attempting to identify the underlying cause of the failed bone healing. Then, a treatment plan is designed to address any physiological factors that may be hindering the healing process.
Nonsurgical Treatment
Sometimes, non-surgical methods like electrical stimulation or specific braces can be used to promote healing and achieve union without the need for an operation.
Orthopedic doctors use nonsurgical methods to treat certain types of fractures that are not associated with a labor union. One common technique that doesn’t involve surgery is using a bone stimulator to promote healing. The procedure works by transmitting ultrasonic or pulsed electromagnetic waves through small devices that are applied to the skin over the affected area. The stimulation is typically administered for a duration of 20 minutes to several hours each day. It’s important to use this treatment daily for it to be effective.
Surgical Treatment
Surgery is often necessary for the majority of nonunions. The primary objectives of surgical treatment for nonunion are threefold:
To create a healthy vascular environment around the fracture site and the surrounding soft tissue. To achieve this, any dead or poorly vascularized bone or scar tissue at the fracture site must be removed. If the nearby tissues are extensively harmed, reconstructive surgery like free muscle flaps, either rotational or microvascular, might be necessary to introduce fresh, healthy tissue to the broken bone area.
To stabilize the fracture site. This typically involves using a rod, plate, or screws. Your doctor may also use an “external fixator”. It involves the use of external pins to hold the bones above and below the fracture in place.
To promote a new healing response in the fracture by stimulating bone growth with a bone graft. Bone grafts often involve obtaining healthy cancellous or “spongy” bone from the pelvis through a small incision at the hip level. This procedure introduces many new bone-forming and supportive cells.
What happens after the surgery?
Dr. Aditya Kapoor gives a few instructions for post-operative care.
While sleeping, raise your upper body and use acetaminophen for pain relief. If you’re wearing a cast, apply heat to the injured area to increase blood flow and help with healing. Once the cast is removed, use ice to massage the injured area.
Ensure you have a healthy diet and exercise regularly to keep the unaffected muscle groups in good shape during the recovery process. It’s essential to avoid smoking, as nicotine can hinder the healing of fractures. Furthermore, try to avoid NSAIDs, chemotherapy, radiation therapy, and systemic corticosteroids as they can all slow down the bone-healing process.
Don’t forget to ask Dr. Aditya Kapoor for complete post-operative instructions.
How long is the recovery period after surgery?
Dr. Aditya Kapoor will use an x-ray to assess if the fracture has completely healed, which will establish how long the recovery process will take. Furthermore, your doctor will give you directions on weight-bearing and physical therapy, as well as guidance on your activities at home.