Nonunion of Femoral Fractures: Treatment Options Explained - Orthopedics

More Info

---

Understanding nonunion of femoral fractures is crucial for determining the best treatment options. Nonunion occurs when a fractured bone fails to heal properly, leading to persistent pain and functional limitations. In your case, it seems that despite the initial surgical intervention in May 2021, the fracture site has not healed as expected, which is indicated by the gap observed in the CT scan.


Treatment Options Explained
1. Biological Augmentation (Blood Injection):
The first option your doctor has proposed involves injecting your own blood into the nonunion site. This method aims to enhance the healing process by providing growth factors and stem cells that can stimulate bone regeneration. While this approach is less invasive and has a reasonable success rate (30-40%), it may not be sufficient for all cases, especially if the nonunion is due to mechanical instability or significant bone loss.
2. Surgical Intervention to Fill the Gap:
The second option involves a surgical procedure where the gap in the bone is filled with graft material. This could be autograft (bone taken from another site in your body), allograft (donor bone), or synthetic bone substitutes. This method is more invasive but can provide a more reliable solution, especially if the nonunion is due to inadequate biological healing. The success of this procedure largely depends on the quality of the graft and the surgical technique used.

3. Removal of Hardware and Revision Surgery:
The third option is to remove any existing hardware (like plates or screws) and to redo the fixation with new implants. This is typically considered when there is a concern that the current hardware is contributing to the nonunion, either by causing irritation or by being inadequately positioned. This option is the most invasive and carries the highest risk of complications, but it may be necessary if the previous treatments have failed.


Factors Influencing Treatment Choice
- Type of Nonunion: Nonunions can be classified as "hypertrophic" (where there is some biological activity but not enough stability) or "atrophic" (where there is little to no biological activity). The treatment approach may differ based on this classification.


- Patient Factors: Your overall health, age, activity level, and any underlying conditions (like diabetes or smoking) can significantly impact healing and should be considered when choosing a treatment plan.

- Fracture Characteristics: The location of the fracture, the quality of the bone, and the presence of any infection or other complications will also guide the treatment decision.


Conclusion
In summary, while there is a possibility for self-healing, especially in hypertrophic nonunions, the likelihood decreases with time and the presence of a gap. Given the options presented by your doctor, it is essential to weigh the risks and benefits of each approach. If you are leaning towards a less invasive option, the blood injection may be worth considering, but if you are experiencing significant pain and functional limitations, a more aggressive surgical approach might be warranted.

It is advisable to have a thorough discussion with your orthopedic surgeon about the potential outcomes, risks, and recovery times associated with each treatment option. Additionally, seeking a second opinion from another orthopedic specialist can provide further insights and help you make a more informed decision regarding your treatment plan.