Neuroma Development in Non-Healing Fractures
Yes, a neuroma can develop in the setting of a non-healing fracture, particularly when there is ongoing inflammation, tissue damage, and nerve irritation associated with the fracture site.
Mechanism of Neuroma Formation in Non-Healing Fractures
- A neuroma is a benign growth of nerve tissue that can develop after nerve injury, typically forming when a peripheral nerve is cut or damaged and attempts to regenerate 1
- In non-healing fractures (fracture nonunion), the persistent inflammatory environment and ongoing tissue disruption can lead to nerve irritation and damage 2
- The prolonged healing process in nonunion creates conditions where damaged nerves may form neuromas as they attempt to regenerate but encounter scar tissue or mechanical barriers 3
Relationship Between Fracture Nonunion and Neuroma Development
- Fracture nonunion is defined as a fracture that will not heal without further intervention, typically after 6-8 weeks of appropriate treatment 4
- The prevalence of fracture nonunion is relatively low, with large epidemiological studies reporting less than 5 cases per 10,000 inhabitants 4
- The inflammatory environment of a non-healing fracture can contribute to abnormal nerve regeneration patterns, potentially leading to neuroma formation 2
Clinical Presentation of Neuroma in Non-Healing Fractures
- Patients may experience neuropathic pain that differs from typical fracture pain - characterized by burning, electric shock-like sensations, or hypersensitivity 1
- Pain may be exacerbated by pressure on the affected area or certain movements 1
- The pain pattern may be paroxysmal (occurring in sudden, severe attacks) 5
- Symptoms may persist despite appropriate fracture management, suggesting a secondary pain generator 1
Diagnostic Considerations
- Clinical examination may reveal a tender, palpable mass or trigger point that reproduces the patient's symptoms 1
- Imaging studies (MRI) may help identify both the non-healing fracture and potential neuroma formation 6
- Diagnostic nerve blocks can help confirm the diagnosis by temporarily relieving symptoms 1
- Electrophysiological studies may demonstrate abnormal nerve conduction in the affected area 1
Management Approaches
- The primary goal should be to address the underlying fracture nonunion, as healing the fracture may resolve the conditions promoting neuroma formation 4
- Surgical options for fracture nonunion include mechanical stabilization with instrumentation, with or without autologous bone grafting 4
- For established neuromas, treatment may include:
Prevention Strategies
- Early appropriate fracture management to promote timely healing and reduce risk of nonunion 3
- Careful surgical technique during fracture repair to minimize nerve damage 1
- Adequate pain control to reduce central sensitization that may contribute to neuropathic pain 6
- Early mobilization when appropriate to prevent stiffness and additional tissue damage 7
Case Example
A documented case describes a 43-year-old woman who developed a symptomatic saphenous neuroma after an open tibial fracture. The neuroma was confirmed clinically, and treatment with neurolysis and partial neurectomy resulted in complete pain relief and functional recovery 1.
Common Pitfalls and Caveats
- Neuromas may be misdiagnosed as persistent fracture pain, leading to inappropriate management strategies 1
- Overuse of the contralateral limb due to pain in the affected limb can lead to stress fractures or other complications in the unaffected limb 5
- Prolonged immobilization attempting to treat nonunion can lead to significant side effects including bone mass loss (1% per week), muscle strength loss (15% after just 10 days), and reduced aerobic capacity 6
- Failure to address both the nonunion and neuroma may result in persistent pain and disability despite interventions targeting only one aspect 1