Problem Fractures

Problem fractures are fractured bones that do not heal properly. These problem fractures can cause pain and limited mobility or movement for months or even years if they do not heal properly. There are two main types of problem fractures: non-union fractures and mal-union fractures. Non-union fractures are fractured bones that fail to heal properly within usually a 6-9-month time frame. Mal-union fractures are fractured bones that heal in an imperfect or faulty position. These mal-union fractures often result in crooked, shortened, or rotated limbs. 

 

Symptoms

• Prolonged pain at injury site

• Deformity

• Altered gait if lower body fracture

• Pain in other areas due to altered mechanics

• Instability of area

 

Causes

• Inadequate stability of the bone while trying to heal

• Poor blood flow to the fracture site (non-union)

• Bone shifting during healing process (mal-union)

• Another injury occurring after the initial fracture injury

 

Risk Factors (of non-union fractures)

• Smoking or nicotine use

• Older age

• Severe anemia

• Diabetes

• Low vitamin D level

• Hypothyroidism

• Poor nutrition

• Anti-inflammatory use

• Infection

• Complicated fracture

 

Prevention

• Have fracture treated immediately after injury and go for regular check-ups to make sure the fracture is healing properly

• Maintain good health and good nutrition

 

Diagnosis

• Physician exam finding gap at fracture site and no progress in bone healing over several months (non-union) or faulty alignment in bone healing (mal-union). Physician should also check range of motion, symmetry of limbs, and gait.

• Blood test to check for an infection or a medical condition such as anemia or diabetes (non-union)

• X-ray

• CT

• MRI

• Scanogram

 

Treatment Options

Non-surgical:

• Bone stimulator machine (non-union)

• Shoe lift or bracing (mal-union)

 

Surgical:

• Bone graft

• Osteotomy to cut and realign bones (mal-union) or to remove non-healing portion of bone to make way for new healthy bone with good blood supply (non-union)

• Internal or external fixation to stabilize the bone, improve function, and improve blood flow to area to facilitate healing

• Distraction osteogenesis to elongate bone using internal lengthening rod or external frame