From the Research
Yes, a patient can experience bone growth even a year after an asymptomatic nonunion. Bone healing is a dynamic process that can continue over extended periods, and spontaneous healing of nonunions can occur even after prolonged periods of time. The body maintains some capacity for bone repair throughout life, though this capacity diminishes with age and depends on various factors including blood supply, mechanical stability, and the patient's overall health status. For asymptomatic nonunions specifically, the lack of pain or functional limitation may indicate that some degree of fibrous stability has developed, but this doesn't preclude the possibility of eventual osseous healing.
Factors that may promote late healing include:
- Improved nutrition (adequate protein, calcium, and vitamin D intake)
- Cessation of smoking
- Better glycemic control in diabetics
- Appropriate mechanical loading of the affected bone Some physicians may consider interventions such as low-intensity pulsed ultrasound or bone stimulators even for late nonunions, though evidence for their effectiveness in long-standing cases is limited, as seen in studies such as 1. If the nonunion remains truly asymptomatic, observation may be reasonable, but patients should be monitored for any changes in symptoms or function that might indicate progression of the condition. The most recent study 1 from 2021, highlights the importance of proper management of nonunions, and how revision surgeries can lead to successful outcomes.
In terms of management, it's essential to consider the underlying cause of the nonunion, as well as the patient's overall health status, as discussed in 2 and 3. The use of external fixation, as mentioned in 3, can be an effective treatment option for certain types of nonunions. Additionally, the concept of the "bone-healing unit" presented in 4 provides a useful framework for understanding the complex process of bone healing and nonunion. However, the most recent and highest quality study 1 should be prioritized when making treatment decisions.
Overall, the key to managing asymptomatic nonunions is to prioritize the patient's quality of life, while also monitoring for any changes in symptoms or function that may indicate progression of the condition, as emphasized in 1.