From the Guidelines
A non-union fracture is typically considered when a broken bone fails to heal properly within 6-9 months after injury. This condition is diagnosed through a combination of clinical evaluation and imaging studies, including X-rays, CT scans, and occasionally MRI or bone scans to assess bone viability 1. The diagnosis of non-union fracture is crucial as it can lead to significant morbidity, mortality, and decreased quality of life if left untreated.
Causes and Risk Factors
Certain stress fractures are considered high-risk based on a tendency for nonunion or delayed union, including the anterior tibial diaphysis, lateral femoral neck and femoral head, patella, medial malleolus, navicular, fifth metatarsal base, proximal second metatarsal, tibial hallux sesamoid, and talus 1. Risk factors for non-union fractures also include smoking, diabetes, poor blood supply, infection, and inadequate initial fracture stabilization.
Diagnosis
Imaging studies play a critical role in the diagnosis of non-union fractures. X-rays can show persistent fracture lines, while CT scans can reveal detailed bone architecture. MRI or bone scans may be used to assess bone viability, especially in cases where the diagnosis is unclear 1.
Treatment
Treatment of non-union fractures depends on the cause and may include non-surgical approaches like bone stimulation devices or surgical interventions. Surgery often involves internal fixation with plates, screws, or rods to stabilize the fracture, combined with bone grafting to stimulate healing. Autografts (patient's own bone) or allografts (donor bone) may be used 1. The goal of treatment is to promote healing, alleviate pain, and restore function to the affected limb.
Recovery and Rehabilitation
Recovery from non-union fracture treatment typically requires several months of rehabilitation, including physical therapy to restore strength and function to the affected limb. Addressing underlying causes and risk factors is crucial for successful treatment, with surgical intervention showing higher success rates for established non-unions 1. By prioritizing the diagnosis and treatment of non-union fractures, healthcare providers can improve patient outcomes and reduce the risk of long-term morbidity and mortality.
From the Research
Definition of Non-Union Fracture
- A non-union fracture is defined as a fracture that fails to heal after a prolonged period, typically more than 9 months, due to inadequate immobilization, failed surgical intervention, insufficient biological response, or infection 2.
- Non-union represents a chronic medical condition that affects not only the function of the affected limb but also the individual's psychosocial and economic well-being 2.
Risk Factors for Non-Union
- Risk factors for non-union depend on specific fractures, but there is a complex interplay of injury severity, comorbidities, patient medication, and infection 3.
- The majority of non-unions occur after long bone fractures, with the tibia, femur, forearm, humerus, and clavicle being the most common sites 3.
Diagnosis of Non-Union
- Traditional reliance on radiographs to monitor union has limitations, as bridging callus of long bone fractures can take three or more months to occur 4.
- Computed Tomographic (CT) scanning is becoming increasingly popular and can evaluate bridging callus in the late stages of healing to confirm union 4.
- Dynamic contrast-enhanced Magnetic Resonance Imaging (MRI) and advances in nuclear imaging may yield benefits in the assessment of infected non-union 4.
- Ultrasound may be useful in detecting bridging callus prior to radiographic confirmation and predicting patients at high risk of non-union 4.
- Bone scanning using Technetium-99m methylene diphosphonate (99mTc-MDP) can predict the healing response to treatment and identify complicated non-unions 5.
Treatment of Non-Union
- The majority of non-unions can be effectively managed with conventional surgical techniques 3.
- Surgical management of non-union aims to restore stability, promote healing, and improve function 3.
- Pulsing electromagnetic field stimulation therapy may be effective in promoting healing in some cases of non-union, particularly those with a favorable scintigraphic pattern 5.