Atrium Health Navicent Musculoskeletal Care Orthopedic Trauma

A woman's arm

What is a Nonunion/Non-Healing Fracture?

Unfortunately, accidents happen, and sometimes a broken bone is involved. Most do heal, either via a cast or surgery, and life goes back to normal. However, it is not uncommon for a bone to not heal. This is called a nonunion and can become a serious situation if it is not addressed and treated properly.

What Causes a Nonunion or a Non-Healing Fracture?

There are several reasons for a fracture not to heal. Some are related to how to was broken, and some may be related to the health of the patient. A few risk factors that make a nonunion fracture more likely are:

  • Diabetes
  • Heavy smoking
  • Hypothyroidism
  • Infection at the fracture site
  • Obesity
  • Poor nutrition
  • Vitamin D deficiency

Any of these can increase the risk of a nonunion fracture, but several of them combined can greatly increase the odds of problems with healing.

What are Nonunion Fracture Symptoms?

The most common symptom of a nonunion of the bone is pain. Whether the extremity is in use, or simply at rest, the pain is present. This can last for weeks, months, or years. It is good to have the doctor check things out if the pain persists and does not resolve or improve.

How is a Nonunion Fracture Diagnosed?

The diagnosis of nonunion requires a medical exam and imaging, such as x-rays, MRI or CT scan. The doctor will check to see if there is any bone healing at the fracture. If there are no signs of healing and the pain is persistent, the diagnosis will most likely be a nonunion fracture.

Is Treatment Intervention Possible?

After the diagnosis of a nonunion, the next step is to determine the cause. This typically involves ordering laboratory studies of the patient's blood, and perhaps more imaging. Once the cause of the nonunion is determined, the doctor will discuss with you the best treatment plan that will likely include both surgical and non-surgical options.

What are the Treatment Options?

There are several ways nonunions are treated, and the basic approach is to address the reason the nonunion developed and then repair the nonunion.

A couple non-operative options are casting or bracing and using a bone stimulator. Immobilizing the nonunion can better enable the fracture to heal. A bone stimulator can facilitate enhanced bone healing through ultrasound waves inducing a biological change. This may be all that is needed to improve the healing process.

Sometimes surgical intervention is needed. The goal of operative care is again to address the cause of the nonunion, and the repair is done surgically to facilitate bone healing. A nonunion may develop after a first surgery was performed, it is likely that another surgery is needed to achieve a successful fracture union.

How Can You Help Increase Bone Healing After Trauma?

Bone healing requires immobilization for a period of time. One way to help bones heal is to avoid the activities and problems that place you at a higher risk. This will help avoid nonunion/non-healing fracture by making sure the area stays stabilized for the time the doctor suggests. Eating a good and well-balanced diet, as well as not smoking, are also critical for your overall health and fracture healing.

The Future of Nonunion Fracture Repair

Scientific research is ongoing towards finding new ways to enhance fracture healing. The goal is to discover new medications or surgical techniques to promote faster healing, decrease the incidence of nonunions, and improve overall function after a fracture does heal.