Non-Union Fractures: Key Questions for Orthopedic Recovery

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Once, I heard a rehabilitation therapist say that if the bone has not healed, any rehabilitation efforts will be ineffective.
Later, I sought treatment at National Taiwan University Hospital, where the doctor advised me to undergo joint mobilization.
Hello, doctor.
I was involved in a car accident last year that resulted in a comminuted fracture of the left ulnar bone.
After surgery, I had internal fixation with a steel nail, but it was removed two months later.
Subsequently, I found out that the fracture had not healed, and there was a loss of cartilage on the joint surface, leading to stiffness and poor flexion and extension angles.
The attending physician only instructed me to undergo joint mobilization therapy (passive flexion and extension performed by the physician under anesthesia).
After five sessions, there was no improvement.
The doctor then advised me to continue rehabilitation, stating that the bone would heal naturally over time (X-rays showed clear signs of non-union after the nail was removed).
I followed his instructions and diligently attended rehabilitation three times a week, fearing the need for bone union surgery.

Dr.
Zhou, I have several questions:
1.
If I do not undergo bone union surgery, will the fracture heal completely on its own?
2.
Is the non-union of the bone due to the surgeon's misjudgment in removing the nail too early? (I have heard that nails are usually removed after a year.)
3.
I have many bone spurs around my elbow; could this be a result of undergoing too many joint mobilization sessions?
4.
How many times should joint mobilization be performed? Is there a risk of ossification, calcification, or degeneration from this procedure?
5.
Will the lack of cartilage affect joint function in the future?
6.
Will undergoing joint reconstruction and bone union surgery improve the range of motion in my elbow, or could it potentially decrease it?
7.
If multiple surgeries are performed on the elbow, will it negatively impact joint function?
8.
I have been injured for over nine months; has the joint already stabilized, and would another surgery be beneficial?
9.
Is it correct to say that if the bone has not healed, any rehabilitation or joint mobilization efforts will be ineffective?
10.
After surgery, if I were to immobilize the elbow completely in a cast, would that be effective, or are there other methods to aid in the recovery of my elbow?
I apologize for the lengthy inquiry, but I would greatly appreciate your responses.
Thank you.

Xiao Yu, 20~29 year old female. Ask Date: 2005/04/07

Dr. Zhou Hongzhi reply Orthopedics

1.
It depends on the duration of time.

2.
It should not be.

3.
Caused by a comminuted fracture.

5.
Yes.

6.
There should be improvement.

7.
Yes.

8.
Possibly.

9.
Yes.

10.
It depends on the location of the fracture.

Reply Date: 2005/04/07

More Info

Understanding non-union fractures is crucial for effective orthopedic recovery, especially in complex cases like yours. Non-union fractures occur when a broken bone fails to heal properly, leading to persistent pain and dysfunction. Given your history of a comminuted ulnar fracture and subsequent complications, it's essential to address your concerns systematically.

1. Will the fracture heal naturally without surgery?
In most cases, non-union fractures do not heal without intervention. Factors such as the type of fracture, the patient's age, overall health, and the presence of any underlying conditions (like osteoporosis) can influence healing. If the fracture site is not stabilized or if there is insufficient blood supply, natural healing is unlikely. Surgical intervention, such as bone grafting or internal fixation, is often necessary to promote healing.

2. Could the early removal of the hardware have caused the non-union?
Yes, premature removal of fixation devices can lead to non-union, especially if the bone has not adequately healed. Typically, orthopedic surgeons recommend keeping hardware in place for at least 6 to 12 months, depending on the fracture's complexity and the patient's healing progress. If the hardware was removed too soon, it could have compromised the stability needed for the fracture to heal.

3. Are bone spurs a result of excessive joint mobilization?
Bone spurs, or osteophytes, can develop due to joint instability, chronic inflammation, or excessive mechanical stress. If the joint has been subjected to repeated passive motion without adequate healing, it may lead to the formation of bone spurs. However, they can also arise from the body’s natural response to joint degeneration or injury.

4. How many times should joint mobilization be performed?
The frequency of joint mobilization should be tailored to the individual’s condition and healing progress. While passive range of motion exercises are essential, they should be balanced with active exercises to promote strength and stability. Overdoing passive mobilization can lead to complications, including stiffness and further joint damage.

5. Will the absence of cartilage affect joint function?
Yes, the lack of cartilage can significantly impact joint function. Cartilage serves as a cushion between bones, allowing for smooth movement. Its absence can lead to pain, swelling, and decreased range of motion, ultimately resulting in osteoarthritis over time.

6. Can reconstructive surgery improve joint function?
Reconstructive surgery can potentially improve joint function, but outcomes vary. If the surgery successfully addresses the underlying issues, such as realigning the bones and repairing soft tissue, it may enhance mobility and reduce pain. However, there is also a risk that surgery could lead to further complications or reduced range of motion if not performed correctly.

7. Will multiple surgeries affect joint function?
Yes, multiple surgeries can lead to scar tissue formation, joint stiffness, and potential complications. Each surgical intervention carries risks, including infection and further damage to surrounding tissues. It’s crucial to weigh the benefits against the risks when considering additional surgeries.

8. Is it too late for surgery after nine months?
While the healing process can become more complicated over time, it is not necessarily too late for surgery. If the joint has not stabilized or healed properly, surgical options may still be viable. Consulting with your orthopedic surgeon about the potential benefits and risks is essential.

9. Is it correct that rehabilitation is ineffective if the bone is not healed?
Yes, if the fracture has not healed, rehabilitation efforts may yield limited results. The focus should be on achieving stability and promoting healing before engaging in extensive rehabilitation.

10. Would immobilizing the elbow in a cast help?
Immobilization can be beneficial in certain cases, particularly if it allows the fracture to stabilize. However, it should be done under medical supervision to ensure that it does not lead to further complications, such as stiffness or muscle atrophy.

In conclusion, your situation requires careful evaluation and a tailored approach. It is vital to maintain open communication with your orthopedic team, discuss your concerns, and explore all available treatment options. Each case is unique, and a comprehensive plan that considers your specific needs and circumstances will be essential for your recovery.

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