From the Research
Bone grafting is not always necessary for a non-union fracture of the proximal phalanx of the left thumb, but it may be considered in cases with significant bone gap, poor vascularity, or inadequate healing after conservative management, as supported by the most recent study 1. The decision to proceed with bone grafting depends on several factors, including the duration of the non-union, patient symptoms, functional limitations, and specific characteristics of the non-union site.
- The patient's overall health status and functional needs should be taken into consideration when making the decision for bone grafting.
- Other surgical options, such as rigid internal fixation with plates and screws, may be attempted before bone grafting.
- If bone grafting is deemed necessary, options include autografts, allografts, or synthetic bone substitutes, and the procedure would be combined with stable fixation of the fracture.
- A hand surgeon should make the decision for bone grafting after thorough clinical evaluation, appropriate imaging studies, and consideration of the patient's individual needs, as seen in the study 1 which reported excellent clinical and functional outcomes with autologous bone grafting in a child with a segmental gap non-union of the proximal phalanx of the thumb.
- The study 2 also suggests that conservative treatment can be an option even for unstable fracture patterns, but this may not be suitable for all cases, and bone grafting may be necessary in certain situations, such as those with significant bone loss or instability.
- Ultimately, the decision for bone grafting should prioritize the patient's morbidity, mortality, and quality of life, and be based on the most recent and highest quality evidence available, such as the study 1.