Delayed Union in Femur Fractures: Symptoms and Solutions

Is a femoral fracture considered nonunion?

This image shows the condition at two and a half months.
The following two images depict my current fracture status (it has been three and a half months).
Since the surgery was performed in Kaohsiung, I have been referred to a doctor in Taipei, who mentioned that my callus is growing, but the bone union is progressing very slowly (only a little growth).
I would like to ask the doctor if this is a symptom of hypertrophic nonunion, as the symptoms seem very similar.
If that is the case, are there any methods to address this? Thank you, doctor!

Niming, 20~29 year old female. Ask Date: 2017/09/07

Dr. Li Yongheng reply Orthopedics

According to your X-ray, it has been three and a half months since your fracture.
The callus is forming, but the union of the bone is progressing more slowly.
It is recommended that you increase your intake of calcium, vitamin D, and get some sunlight.
You may lightly bear weight on the affected limb to stimulate fracture healing.
Of course, regular follow-up appointments for X-ray examinations and adhering to your attending physician's advice are even more important.
Wishing you a speedy recovery.

Reply Date: 2017/09/07

More Info

Delayed union in femur fractures is a condition where the healing process of a fractured femur takes longer than expected. Typically, a femur fracture should show signs of healing within 6 to 12 weeks, depending on various factors such as the patient's age, overall health, and the nature of the fracture itself. When healing is delayed, it can lead to complications such as non-union or malunion, which can significantly affect mobility and quality of life.

Based on the images you provided and the information regarding your condition, it appears that you are experiencing delayed union. The presence of bone callus (or bone callus formation) is a positive sign, indicating that the body is attempting to heal the fracture. However, if the bone ends are not properly aligned or if there is insufficient blood supply to the area, the healing process may be hindered.

Symptoms of Delayed Union
1. Persistent Pain: Pain at the fracture site that does not improve over time.

2. Swelling: Continued swelling around the fracture area.

3. Limited Mobility: Difficulty in moving the affected limb, which may be accompanied by stiffness.

4. Visible Deformity: In some cases, the limb may appear deformed or misaligned.

Possible Causes of Delayed Union
1. Inadequate Blood Supply: Blood flow is crucial for healing; any disruption can delay the process.

2. Infection: An infection at the fracture site can impede healing.

3. Poor Nutrition: Lack of essential nutrients, particularly calcium and vitamin D, can affect bone healing.

4. Smoking: Tobacco use has been shown to negatively impact bone healing.

5. Underlying Health Conditions: Conditions such as diabetes or osteoporosis can complicate the healing process.

Solutions and Management
1. Regular Monitoring: Follow-up with your orthopedic surgeon is essential. They may recommend regular X-rays or CT scans to monitor healing progress.

2. Physical Therapy: Engaging in physical therapy can help improve mobility and strengthen the surrounding muscles, which can support the healing process.

3. Nutritional Support: Ensure you are consuming a balanced diet rich in calcium and vitamin D. Supplements may be necessary if dietary intake is insufficient.

4. Avoid Smoking and Alcohol: Both can impair bone healing, so it's advisable to avoid these substances.

5. Surgical Intervention: In cases where there is significant delay in healing, surgical options such as bone grafting or the use of bone stimulators may be considered to enhance healing.

6. Bone Stimulation: Some patients benefit from electrical stimulation devices that promote bone healing.

Conclusion
It is crucial to maintain open communication with your healthcare provider regarding your symptoms and progress. If you suspect that you are experiencing delayed union, it is essential to address this with your doctor promptly. They may suggest further imaging studies or interventions to facilitate healing. Remember, while delayed union can be frustrating, many patients eventually achieve successful healing with appropriate management. Your proactive approach in seeking information and treatment options is commendable and will aid in your recovery journey.

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