With the advancement of technology, the treatment of bone fractures is now performed very successfully. We do not frequently encounter problems of fracture malunion or nonunion. However, malunion or nonunion of a fracture creates a serious problem for the patient. The treatment process is more challenging compared to normal fractures. In this article, we will first discuss fracture malunion and its treatment. Subsequently, we will address fracture nonunion problems.
Nowadays, simple fractures and pediatric fractures are generally treated with casting. More complex fractures and many adult fractures are treated surgically. In both treatment methods, the patient’s fracture is fixed (stabilized) by achieving what we call anatomic, the original alignment. Fracture fragments in a cast can shift due to muscle forces. For this reason, it is important for patients treated with casts to attend their check-ups on the days their doctors call them for follow-up and have X-rays taken. Although very rare in surgically treated patients, malunion can occur as a result of early weight-bearing on the plates used. In malunion, when the angulation is excessive (generally angulation exceeding 10 degrees), it can cause limping in the patient and difficulties in using their arm or hand. Additionally, it causes pain in the joints related to the fracture in the early period and arthrosis (calcification/osteoarthritis) in the advancing period. When a patient’s fracture has healed incorrectly, appropriately taken X-ray films are requested by the specialist you consult. Measurements are made on these films. A fracture healing with angulation up to certain degrees may not cause health problems. However, in cases where healing occurs with angulation above these limits, the bone is surgically re-fractured (osteotomy) at the appropriate location. After alignment of this newly created fracture is achieved, it is fixed (stabilized) with an appropriate method. Proper healing of the bone is ensured.
Another important situation for bone fractures is delayed union or nonunion. There are two conditions necessary for a fracture to heal. The first is that the bone must have good blood supply, and the second is that the bone must be firmly fixed (stabilized). In what we call high-energy (such as falls from height, traffic accidents…) bone fractures, the bone sustains significant damage. In this situation, problems can occur in the viability of the bone. In many of these types of fractures, the skin integrity over the bone is disrupted and the fracture becomes an open fracture. In open fractures, there is a high probability that the bone will lose its viability. The healing process of such a fracture will be longer. As this process extends, we encounter healing problems in the fracture. Another important reason that creates healing problems in bone fractures is the aforementioned problem in fracture fixation. Due to the shape and location of some fractures, complete fixation with plates or nails may not be achievable. In these cases, even though the viability of the bone is intact, small movements at the fracture ends will prevent fracture healing. At this point, it should be mentioned that another factor that delays fracture healing is the patient’s smoking.
There are no strictly defined limits for saying that there is a healing problem in a fracture. If a bone fracture does not heal within the expected time or if no healing signs are detected on X-ray films taken during check-ups, there is delayed union or what we call pseudoarthrosis (nonunion/false joint) in this fracture. When such a situation is encountered, a long process may begin for the patient. The patience of the patient and doctor is important for treatment. First, the factors preventing fracture healing must be identified. The bone that has lost its viability is usually treated by placing bone grafts (transplants) taken from the pelvic bone. In cases where the fixation method delays fracture healing, the implants placed are removed, and the bone fracture is fixed more securely. Such patients should definitely not smoke. Many of our patients ask what they can eat for fracture healing. Scientific studies only indicate that smoking prevents fracture healing. For fracture healing, it is sufficient to continue consuming the same foods you normally consume.
Medical Disclaimer: This content is for informational and educational purposes only and should not be considered as medical advice, diagnosis, or treatment. Always consult with a qualified healthcare professional regarding any medical condition or treatment decisions.