Most broken bones heal without any problems. After initial treatment, usually new bone tissue forms and connects the broken bone pieces together. However, in some patients some fractures do not heal despite medical treatment. A non-union fracture, also known as a non-healing fracture, occurs when a broken or fractured bone does not heal in the expected period of time.
The expected healing time for each bone can vary - for example, the forearm bones are expected to fully heal in 3-4 months, whereas the thigh bone can take anywhere from 6-12 months. In general, we consider the possibility of a non-union fracture if there is no sign of healing around 6-9 months after the fracture occurs.
There are generally 3 types of non-union fractures observed:
Hypertrophic non-union fractures:
Hypertrophic non-union fractures are a result of instability of the fixation or metalwork used to fix a fracture. On x-rays we can see a significant lump of new bone formation with a tiny line running where the previous fracture was. What we need to achieve is additional stability of the non-union and the fracture will unite in a relatively short period of time. This can be achieved by adding additional screws to the fixation of exchanging the metalwork to achieve better compression on the non-union site. Success rate for this type of non-union is usually very high.
Eutrophic non-union fractures:
Eutrophic (oligotrophic) non-union fractures are usually caused by multiple factors like fracture instability, lack of blood supply to the bone ends, inadequate fixation or low grade infection which does not present itself clinically..
If patients with eutrophic non-union fractures require surgery, they will be advised not to take any antibiotics at least two weeks prior to the surgery to improve the chances of identifying any potential infection. During the surgery itself we would remove all the existing metalwork and take microbiology tissue samples which can be investigated in the lab to look for potential infections. In the majority of the cases we would proceed with the non-union refixation after all the metalwork has been removed. The refixation will include insertion of poller screws (2-4 screws in different planes), reaming the canal and fixation with a rod. Throughout the procedure we use intraoperative X-ray to monitor the progress and position of the metalwork inserted. Depending on the type of fixation achieved you will be advised whether you can weight bear or not post operatively. Unless there will be a high risk of infection you won’t be given any antibiotics post operatively.
If the tissue samples taken during the surgery show any sign of infection (usually takes 7-10 days for the lab to process the samples) you will be advised which antibiotics to take. The duration of antibiotic treatment post surgery is usually around 6 weeks.
Atrophic non-union fractures:
Atrophic non-union fractures occur when the bone ends have a very limited or nonexistent blood supply or parts of the bone are missing. There is almost certainly infection present. X-ray and CT scans will usually show significant instability of the metalwork with bone defects. In patients with atrophic non-union fractures, we have to be aggressive in treatment otherwise the condition can get worse and it can become more difficult to treat.
Treatment may involve surgery to remove the infection, to better stabilize the fracture, or to stimulate bone growth with bone graft. The main treatment is re-fixation of the non-union fracture. This can be done either by using the method of fixation as before, although most surgeons agree that it is worth considering changing the method of fixation. For the fixation method, any surgical fixation technique can be used (intramedullary nail, plate and screws, fine wire frames (TSF, Ilizarov)).
During your consultation with Mr Matija Krkovic, you will be explained in detail what the surgery will involve and which method in particular has been chosen to treat your nonunion fracture.
Each person's recovery period will vary, based on how well their body can heal. Mr Krkovic will carry out x-rays after the surgery to assess how well the fracture is healing which will determine the length of recovery period.