Delayed Healing in Forearm Fractures: What to Expect

Q: Delayed Healing in Forearm Fractures: What to Expect

Hello： In response to your question... <br>It is not absolutely abnormal to not see sufficient callus formation three months after surgery for a long bone fracture, as the reasons for fractures, the nature of the fracture, the treatment methods, and the initial bone quality can v

Fracture

Hello Dr.
Lee,
I would like to ask you a question.
At the end of September, I fractured the middle part of my right forearm's ulna and underwent surgery for plate fixation.
As of yesterday, December 21, during my follow-up appointment, the doctor determined that the gap in the fracture still appears too large and seems not to have fully healed.
Is this situation normal? If it does not heal after some more time, will I need another surgery? Or are there other methods to address this issue? Thank you.

Xiao Deng, 30~39 year old female. Ask Date: 2004/12/22

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question...
It is not absolutely abnormal to not see sufficient callus formation three months after surgery for a long bone fracture, as the reasons for fractures, the nature of the fracture, the treatment methods, and the initial bone quality can vary from person to person.
Theoretically, delayed union is defined as a lack of healing after three to five months post-fracture treatment, with another definition being six months.
Nonunion is defined as a lack of healing after six to eight months, with another definition being nine months.
If there is a phenomenon of delayed union after fracture surgery, the following treatments can be considered: 1.
Observation: Some individuals simply have slower bone healing.
2.
Cast immobilization: Internal fixation combined with external fixation to increase stability.
3.
Electrical stimulation: Currently less commonly used.
4.
Ultrasound stimulators: Not covered by health insurance, available in personal and multi-user models, with clinical effectiveness of 30-50%.
5.
Shockwave therapy: Larger machines, available in only a few regional hospitals, and also out-of-pocket, with effectiveness comparable to ultrasound.
6.
Bone marrow or bone growth factor injections: Bone marrow is extracted from the body, mixed with synthetic bone growth factors, and injected into the non-healing site, which is a currently popular development.
7.
Surgical treatment: Nonunion can be broadly classified into two categories.
One type is characterized by insufficient callus formation, which requires the removal of necrotic tissue obstructing bone growth from the fracture ends, along with the addition of autologous cancellous bone and bone marrow fluid, as well as stable internal fixation, significantly increasing the chances of success.
The other type involves excessive callus formation but still results in nonunion, typically due to insufficient stability of internal fixation.
If a plate fixation is used, the plate needs to be lengthened; if an intramedullary nail is used, a larger diameter nail or a locking intramedullary nail may be required.
In your case, a surgical intervention is necessary...
Department of Health, Keelung Hospital, Executive Yuan, Li Wen-Lin.

Reply Date: 2004/12/22

More Info

Hello,
Thank you for your inquiry regarding your forearm fracture and the concerns about delayed healing. It’s understandable to feel anxious when faced with the possibility of complications following a fracture, especially after surgical intervention.
First, let’s discuss the healing process of bone fractures. Generally, bone healing occurs in several stages: the inflammatory phase, the reparative phase, and the remodeling phase. After a fracture, the body initiates a healing response that involves the formation of a blood clot at the fracture site, followed by the development of a soft callus made of collagen and cartilage. Eventually, this soft callus is replaced by a hard callus of bone. The entire process can take several weeks to months, depending on various factors, including the type of fracture, the age and health of the patient, and the quality of the surgical intervention.

In your case, since you underwent surgery with plate fixation, the expectation is that the bone should start to heal within a few weeks. However, if your doctor has noted that the gap between the fractured ends (the fracture gap) is still significant after several months, this could indicate a delayed union or non-union. Delayed union refers to a fracture that is taking longer than expected to heal, while non-union is when the fracture fails to heal altogether.

Several factors can contribute to delayed healing in fractures, including:
1. Inadequate stabilization: If the fixation device (like the plate in your case) is not providing sufficient stability, it can hinder the healing process.

2. Poor blood supply: Bones require a good blood supply for healing. If the fracture site has compromised blood flow, healing may be impaired.

3. Infection: An infection at the fracture site can significantly delay healing.

4. Patient factors: Age, nutritional status, underlying medical conditions (like diabetes), and lifestyle factors (such as smoking) can all affect bone healing.

If your fracture is indeed not healing as expected, your doctor may consider several options before resorting to another surgery. These may include:
- Bone Stimulation: Devices that use electrical or ultrasonic waves to promote bone healing can be considered.

- Bone Grafting: In some cases, adding bone graft material to the fracture site can help stimulate healing.

- Physical Therapy: Engaging in physical therapy may help improve circulation and promote healing, although this should be done under the guidance of your healthcare provider.

If after a reasonable period there is still no sign of healing, your doctor may recommend surgical intervention to address the issue. This could involve revisiting the fixation method, possibly using a different type of implant, or addressing any underlying issues that may be preventing healing.

It’s essential to maintain open communication with your healthcare provider. They can provide you with the most accurate assessment based on your specific situation and imaging results. If you have concerns about the healing process or the need for further intervention, do not hesitate to discuss these with your doctor during your next appointment.

In summary, while it is not uncommon for some fractures to take longer to heal, especially in complex cases, there are various strategies to encourage healing. Your healthcare team is best equipped to guide you through this process and determine the most appropriate next steps based on your individual circumstances.

Wishing you a smooth recovery and healing process.

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