What Is A Nonunion Fracture?
With the available modern treatment methods, most of the fractured or broken bones heal without any problems. After the treatment to the broken bone, it takes a few months to occur new bone tissue and begins to connect to the broken pieces.
In some cases, the fractured bones do not heal even after treatment then this fracture is considered to be a nonunion fracture. Sometimes people might be confused another term delayed union. It is a fracture where the fractured bone takes longer time to heal.
What Are The Types Of Nonunion Fracture?
There are different types of nonunion classified based on various factors which include:
- Septic nonunion caused by an infection
- Hypertrophic nonunion caused due to inadequate stability or formation abundant callous
- Atrophic nonunion caused due to inadequate immobilization and blood supply
- Oligotrophic nonunion
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The fractured bone needs to be stabilized, probably with a cast or surgically implanted plates, screws or nails in the process of healing. However, there were certain conditions that alter the healing process and forms a nonunion fracture.
- If the supply of blood is interrupted by the fracture
- If two ends of the fracture are not aligned properly i.e, the ends are not next to each other
- If the fracture is not fixed
- Soft-tissue imposition
- Bone loss at the fracture
- Damage of surrounding muscles
What Are The Risk Factors Of Nonunion Fracture?
There were certain risk factors that make a bone fail to heal and increases the risk of nonunion.
- Use of tobacco or tobacco products and drinking alcohol inhibits bone healing and increases the risk of a nonunion
- Older age
- Poor nutrition
- Severe anaemia
- Genetic predisposition
- A low vitamin D level
- Metabolic disturbance(Hypothyroidism)
- A complicated break that is open or compound
Certain medications like anti-inflammatory drugs might also increase the risk of nonunion. Patients should discuss the benefits and risks factors involved in using these medications during the healing process of fracture.
Even after the treatment, there are some risk factors that can lead to nonunion which include inadequate reduction of bone, insufficient immobilization and improper fixation of the devices.
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Usually, patients with nonunions complain about persistent pain at the site of the fracture even after it disappears. You may also observe abnormal movement or ticking sound at the site of fracture. Pain may last for months or even years and it may be constant or might occur only when the broken part is used.
How To Treat Treatment Nonunions?
Nonunions can be treated surgically and nonsurgically as they have their advantages and disadvantages. More than one option might be suitable and you should discuss with the doctor about the benefits and risks before treating your nonunion that is right for you.
Some nonunion fractures can be treated nonsurgically. Bone stimulator is a common nonsurgical treatment for nonunion. This procedure involves delivering ultrasonic or pulsed electromagnetic waves through small devices that stimulate the healing process. The stimulator is placed on the skin over the nonunion area for about 20 minutes to several hours daily. This treatment will be effective only if it is used every day.
Surgical Treatment For Nonunion
Surgery is required when nonsurgical treatment for nonunions fail. Sometimes a second surgery may be needed when the first surgery failed. Surgical treatment for nonunions includes bone graft or bone graft substitute, internal fixation, and external fixation.
Bone Grafting: This is a procedure where a bone is taken from another part of your body to stimulate the bone healing process. A bone graft helps to provide a structure where the new bone grows. Bone grafts have another benefit as it provides fresh bone cells and the chemicals that occur naturally in the body required for bone healing. The amount of bone extracted from another part does not cause any functional, structural, or cosmetic problems.
Allograft (cadaver bone graft): An allograft is a procedure where the required bone is taken from a deceased donor or a cadaver. This cadaver bone graft is processed and sterilized and stored in a tissue bank.
Bone graft substitutes and/or osteobiologics: Like allografts, bone graft substitutes also doesn’t involve the harvesting of the bone. Even though bone graft substitutes may not provide the fresh bone cells required for normal healing but they provide a scaffold chemical that stimulates the growth.
Based on the nonunion type, any of the above combinations of procedures may be used to fix the nonunion. Bone grafts alone might not provide stability to the fracture site unless it is inherently stable, some other surgical procedures like internal or external fixation are required to improve stability.
Internal Fixation: Internal fixation helps to stabilize a nonunion. In this procedure metal plates and screws are attached to the bone or places a rod inside the bone canal.
External fixation: External fixation also stabilizes the fractured bone. In this procedure, a stiff frame is attached outside the fractured part. The frame is fixed with the help of wires or pins.