What is a Nonunion?
Most fractured bones in adults heal within 3-6 months. A nonunion, is when a bone has not healed within 6-9 months. The healing process at this point has stopped and further progress is unlikely. In these cases, something must be changed in order to restart the healing process. Usually this requires specialized surgery which must be tailored to the unique situation and to the individual needs of the patient. The type of previous treatments, the condition of the bone and skin and the overall health of the patient all play a critical role in deciding on the best next steps.
Can Surgery Help?
Once a nonunion has been diagnosed, surgery to enable healing is planned. The type of surgery varies with the location of the bone and the type of nonunion. Nonunions without infection and with some evidence of healing may require placement of metal plates, intramedullary nails or specialized external fixation devices to improve stability of the fracture. Improving stability permits new blood vessels to form in the area and promote formation of new, stronger bone.
What is a Bone Graft?
In some cases, the bone healing potential may be low and bone graft must be added to help turn on the healing. Bone graft is most effective when the patients own, live bone is used as this bone has cells, proteins and other substances that help stimulate bone healing. Bone grafts are commonly taken from the pelvic wing bone or from within the femur , using a technique called RIA (Reamer Irrigator Aspirator). The RIA technique has the advantage of using a small incision and providing a large amount of bone graft while causing minimal discomfort. RIA is a relatively new technique but the MOTUS group and others around the world have documented excellent and safe results.
Will I Be Able To Walk After Surgery?
Uninfected nonunions can usually be fixed in one surgical procedure and using modern fracture fixation techniques, most patients are permitted to walk soon after surgery.
In some cases a nonunion may be accompanied by an infection. This changes the treatment in that the infection must be eradicated in order to help heal the fracture.
What If My Bone Is Infected?
In some cases, infected bone and tissue will need to be removed. Often, the surgery must be done in two or more stages. If infected or dead bone is removed, there are several techniques to recreate or regrow the missing bone and to gain healing of the nonunion. Bone transport using specialized external fixators to move and grow bone within the body are a safe and effective method. Delayed bone grafting is also safe and effective in combination with thorough cleaning and placement of stable metal implants. The best technique for a given situation must be carefully determined through ongoing evaluation and discussion between the patient and the surgeon.
The OrthoONE Approach
Nonunions and infected nonunions are difficult challenges for both the patient and surgeon. Healing rates are lower than for fresh fractures. In many cases there has been a long period of pain and suffering and many patients are disabled physically and emotionally by their situation. We believe that these problems are highly specialized and require a specialized team with training and experience who are committed to finding the unique solution for each patient.