Nonunion Fractures: Causes, Treatments, and Recovery

The issue of nonunion in fractures?

I apologize for the inconvenience, but I have some questions I would like Dr.
Chen to answer regarding the issue of nonunion after a fracture.
I was injured in a car accident on June 20, 2015, resulting in a fracture of my left ankle.
At that time, I only received cast treatment and used crutches without putting weight on my foot.
About seven weeks later, the cast was removed, and I continued to use crutches and underwent rehabilitation.
By early September, I was able to walk without crutches.
At that time, I did not feel any significant pain while walking, but my foot was still swollen, and I could not walk too fast or for too long.
However, as I continued to walk, the area of the ankle fracture began to hurt more, and I also experienced numbness.
I returned to the orthopedic clinic, where the orthopedic surgeon informed me that the fracture site had not fully healed, indicating a nonunion fracture.
This means that my ankle cannot bear weight, and any exertion causes pain at the fracture site.
Now, I am also experiencing pain and numbness on the top of my foot.
The orthopedic surgeon has recommended surgery to place a plate and screws at the fracture site to enhance the support and stability of the bone, which would not need to be removed later.
Since it has been nearly five months since my fracture, I would like to ask Dr.
Chen if surgery is absolutely necessary for this type of nonunion fracture, or are there other treatment options available? Additionally, if surgery is indeed required, how long is the expected recovery time? How long will it take from using crutches to being able to walk normally? Will I need to continue rehabilitation? I have attached previous X-ray images: 1040828 http://i.imgur.com/FUyeC8k.jpg, 1040819 http://i.imgur.com/migvAj9.jpg, 1040708 http://i.imgur.com/1WOFLUC.jpg.
Can you confirm if the bone has truly not healed, or if there are other areas that may be injured? I apologize for the numerous questions, and I appreciate Dr.
Chen's assistance.
Thank you.

hen fan nao, 30~39 year old female. Ask Date: 2015/11/14

Dr. Chen Yongxue reply Orthopedics

Hello, regarding the X-ray you attached in your letter, the most recent one was taken on August 28, which is about two months after the injury date.
Do you have any more recent images for reference? Additionally, if possible, I recommend visiting the clinic in person to first determine the source of the pain.
If the pain is indeed coming from the fracture site and there have been no signs of healing on X-rays taken over six months, then surgery may be necessary.
Thank you.

Reply Date: 2015/11/14

More Info

Nonunion fractures, or fractures that fail to heal properly, can be a significant concern following an injury. In your case, it appears that you sustained an ankle fracture from a car accident and have been experiencing persistent pain and discomfort even after the initial treatment. This situation is not uncommon, and understanding the causes, treatments, and recovery options for nonunion fractures can help you navigate your current condition.

Causes of Nonunion Fractures
Nonunion fractures can occur for several reasons:
1. Inadequate Blood Supply: Bones require a sufficient blood supply to heal. If the blood flow to the fracture site is compromised, healing may be impaired.

2. Infection: An infection at the fracture site can hinder the healing process and lead to nonunion.

3. Mechanical Instability: If the fracture fragments are not properly aligned or stabilized, they may not heal correctly. This is particularly relevant in cases where the fracture is displaced or involves joint surfaces.

4. Patient Factors: Certain medical conditions (like diabetes or osteoporosis), smoking, and poor nutrition can also affect bone healing.

5. Type of Fracture: Some fractures, particularly those that are comminuted (broken into several pieces) or involve the joint, are more prone to nonunion.

Treatment Options
When it comes to treating nonunion fractures, surgical intervention is often recommended, especially if conservative measures have failed. Here are some common treatment options:
1. Surgical Fixation: This typically involves the use of plates, screws, or rods to stabilize the fracture and promote healing. In your case, the recommendation to use a bone plate and screws is a standard approach to enhance stability at the fracture site.

2. Bone Grafting: In some cases, a bone graft may be used to provide additional support and stimulate healing. This can be done using bone from another part of your body or from a donor.

3. Electrical Stimulation: Some surgeons may recommend electrical stimulation to promote bone healing, especially in cases where traditional methods have not been successful.

4. Rehabilitation: Post-surgery, physical therapy is crucial to regain strength and mobility. The duration of rehabilitation can vary based on the severity of the injury and the individual's overall health.

Recovery Timeline
The recovery timeline after surgery for a nonunion fracture can vary widely. Generally, you can expect:
- Initial Healing: The bone may take anywhere from 6 to 12 weeks to begin healing, depending on the complexity of the fracture and the surgical intervention.

- Weight Bearing: After surgery, your doctor will provide guidelines on when you can start bearing weight on the affected leg. This is typically gradual and may involve using crutches or a walker initially.

- Physical Therapy: Rehabilitation often begins shortly after surgery, focusing on gentle range-of-motion exercises before progressing to strengthening exercises. The total duration of physical therapy can range from a few weeks to several months, depending on your progress.

Conclusion
In summary, nonunion fractures can be challenging, but surgical intervention is often necessary to promote healing. It is essential to follow your orthopedic surgeon's recommendations closely and engage in a structured rehabilitation program to maximize your recovery. If you have concerns about your healing process or the need for surgery, do not hesitate to discuss them with your healthcare provider. They can provide personalized advice based on your specific situation and help you understand the best path forward for your recovery.

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