When you have had a fracture or broken bones, the fracture gets healed faster than in olden days with the help of modern treatment methods without any problem. After proper treatment to a broken bone, it may take a few months to build new bone tissue to connect to the broken pieces.
However, in some people, a fractured bone may not heal even after proper treatment. The absence of a stable union at the site of fracture even after 9 months from the treatment, then these type of fractures are considered as a nonunion fracture. U may confuse with other similar fracture called delayed union. It is a type of fracture in which the fractured bone heals but takes longer time to heal. It happens in 10–15% of all fractures.
Types Of Nonunion Fractures
There are different types of nonunion classified based on various factors which include:
Septic nonunion: If the union of the fracture is delayed due to bacterial infection to the bone is called a septic non-union fracture. Fixation elements play a key pathogenetic role in the infection.
Pseudarthrosis nonunion: When a fracture with nonunion which results in a joint like motion is called as Pseudarthrosis or a “false joint”.
Hypertrophic nonunion: It is caused due to poor and improper fixation fracture joints, even though callus is formed.
Atrophic nonunion: No formation of callus due to lack of blood supply or low metabolic raite or impaired metabolic rate due to diabetes, hyperthyroidism, and smoking, etc.,
Oligotrophic nonunion: Oligotrophic Nonunions are to Hypertrophic nonunion, but they are not hypertrophic. They are vascular, no formation of callus and due to severely dislodged fracture or fixation without accurate positioning of bone fragments.
Causes & Risk Factors OF Nonunion Fracture
Stabilization of the plays a key role in a fracture, with the help of cast, plates, screws or nails that are implanted for support. However, some conditions can alter the process of healing that results in a nonunion fracture.
- Inadequate blood supply at the site of the fracture
- Improper alignment of bony ends of the fracture
- Slow healing
- Soft-tissue imposition
- Infections at site of the fracture
- Bone loss
- Damage to surrounding tissues or muscles
When you have had a fracture, there were possible risk factors involved which increases the risk of nonunion.
- Having the habit of smoking and using other tobacco products, drinking alcohol inhibits the bone healing process and may result in nonunion
- Increasing age
- Lack of nutrition
- Anaemia problem
- Genetic problems
- Lower levels of vitamin D
- Hypothyroidism and hyperthyroidism
- Compound fractures
During the recovery process after a fracture, you are suggested to take anti-inflammatory drugs. You should discuss with doctors regarding benefits and risks factors involved because they might also increase the risk of nonunion. Inadequate reduction of bone, improper fixation of the implants and lack of mobilization can also lead to nonunion.
Treatment For Treatment Nonunions
Nonunion fractures can be treated either surgically or nonsurgically and they have their own advantages and disadvantages. More than one treatment option is suitable, so better discuss with the expert doctor regarding the ideal treatment option.
Nonsurgical Treatment For Nonunion
Bone stimulator, a common nonsurgical treatment option for nonunion fractures. This is a procedure where ultrasonic or pulsed electromagnetic waves are delivered through a small device to stimulate the healing process. The stimulator is arranged in such a way that it is as close as possible to the nonunion fracture area for about 20 minutes to several hours daily. The treatment will be useful only when it is practised every day.
Anabolic medication like teriparatide, a parathyroid hormone which increases the rate of bone formation in case of acute fractures and nonunion fractures while healing. It might speed the healing process by increasing the calcium levels in the blood and stimulates the bones to grow new tissue. Teriparatide medication is given as an injection which can also be taken at home.
Surgical Treatment For Nonunion
Surgical treatment for nonunion is when nonsurgical treatment fails or can’t be fixed with conventional treatment. In some cases, a second surgery might also be necessary. Surgical treatment includes bone graft or internal fixation, external fixation etc.
Bone Grafting: Bone grafting is an innovative procedure that involves stimulating the healing process with the help of bone taken from another part of your body. This bone graft helps to create a structure by growing bone. Bone grafts provide new bone cells and also the elements that generate naturally in your body needed for bone healing. The bone taken from your body part does not create any functional, structural, or cosmetic problems.
Bone graft substitutes: It is also termed as osteobiologics. Bone graft substitutes provide a scaffold chemical which stimulates the growth of bone at the site of fracture. Bone graft substitutes don’t require harvesting of the bone from your body.
Allograft (cadaver bone graft): In an allograft procedure the required bone is obtained from a deceased donor. The bone graft is then processed, sterilized and stored safely in a tissue bank.
According to the type of nonunion you are facing, a single or combination of procedures might be done to fix the nonunion fracture. In the case of bone grafts, the procedure alone may not provide stability, unless it is inherently stable. So, to provide support and stability procedures like internal or external fixation may be performed.
Internal Fixation: This is a procedure in which the fracture is stabilised with the help of metal plates and screws fixed to the bone or by placing a rod inside the bone canal.
External fixation: This is a procedure in which the fracture is stabilised by fixing a stiff frame from outside the fractured part with the help of wires or pins.