Non union fracture and surgery the best advice you can get

How does bone heal

How our surgery saved a 63 year old person from Non – Union bone fracture?

A 63-year-old person from Bellary, recently visited us with symptoms of severe pain, swelling and softness (tenderness) around the bone area of the (humerus) upper arm. On investigating what the reason of this unknown pain was, we found that he had a completely broken bone which had turned into a non-union fracture. He previously had 4 operations which did not get him any relief. The fifth surgery was done by our team at Sri Sri Holistic Hospital under the guidance of Dr. Venkat Ram Prasad Vallamshetla (MBBS, MS – Orthopaedics).  We have successfully treated the patient and he is in the recovery phase now.

If you or anyone you know, are experiencing similar symptoms like severe pain, swelling,    deformed look and softness of any bony area, this article might help you understand your problem better.

What is a non-union fracture?

Causes for Non-union

Non-union fracture is a permanent fracture of a which fails to heal without any external involvement. It is very common especially in the elderly age group of 50 years+.

Non-union fracture becomes a serious complication and may occur when the fracture is in constant motion, gets infected or receives poor blood supply. Smoking increases the possibility of a complicated non-union fracture in patients. The process of bone healing gets delayed and in some cases, a false joint (pseudarthrosis) develops. A false joint refers to fragments of the fractured bones, which are recognized by the body as two different bones.

If a non-union is evident for 6 months after the injury, it will remain unhealed without any  treatment or any orthopedic surgery.

A non-union which goes on to heal is called a delayed union.

What is a delayed union and what causes it?

Delayed union occurs when a bone fracture takes a longer time to heal, than the average time it must take. The healing time for fractures differs with time, location and configuration of the dislocated bones. It also varies with the specific bones and age groups.

So let us now understand how bone healing happens and the factors that are important in the process of healing the bone.

How does bone heal?

 Non – Union bone fracture

Bone healing is a physiological process in which the body enables the repair of a bone fracture/ broken bone. Bone healing is determined by the strength of a connective tissue membrane called periosteum, that covers the bone. The periosteum is a source of cells which develop into (osteoblasts), single nucleus cells and (Chondroblasts), cells that form cartilage. These cells help in the healing of the bone. The bone marrow and small blood vessels are other sources of these bone supporting cells.

Factors involved in bone healing process:

The fractured bone is not disturbed

A basic bone fracture treatment consists of pushing broken and displaced bones back in place. The complete regeneration of the bone depends on the angle of dislocation of the bone. Stabilizing the position of displaced bones to bring them together, requires absolute rest from movement. This reduction in motion results in the natural healing of the bone. In some cases, fractures may require surgical fixation. This surgical procedure involves attaching the broken bones with devices like rods, plates, screws, and  frames.

Sufficient Blood Supply is important for the bone to heal

Blood carries the essential components that are needed for the healing of the fractured area. These components are healing cells, oxygen and the body’s own chemicals which are growth factors in the human body. Blood supply removes metabolic waste from the body, such as carbon dioxide and acid. This helps the bone receive around 10% of fresh and oxygenated blood which provides a much higher degree of repairing tissues that help regrowth of the cartilage.

Healthy Nutrition helps the blood flow, which is required for healing of fractured bone

Sufficient nutrient intake is an important factor that affects the fracture repair. A well-balanced diet, rich in proteins, calcium, vitamin C, and D should be followed. In exceptional cases where the patient suffers from many injured organs or other health complications, the doctor will suggest guidelines for additional dietary supplements.

Now that we know how a fractured bone heals, and what factors help in the process of healing, let us look at the symptoms, types and causes of a non-union.

Symptoms of non-union

  • Pain
  • Swelling 
  • Deformity
  • Tenderness

Types of Non-union

  • Hypertrophic non-union: Hypertrophic non-union, commonly known as “Elephant foot” is a type of non-union that has too much Callus formation. Callus is a hardened part of the skin or healing tissue, which forms around the ends of a broken bone. This could happen due to excess friction or motion.
  • Oligotrophic non-union: It has blood supply with little or no callus formation. It generally occurs  due to major displacement in a fracture.
  • Atrophic non-union: This is often due to lack of blood supply, and the ends of the fragmented bones become delicate and brittle (osteoporotic or atrophic). Metabolic causes like diabetes, and habits like smoking play an important role in the bones to become weak. Failure of initial healing when the  bone fragments are separated by the soft tissue may also lead to atrophic non-union. Atrophic non-union is treatable by improving fixation of the fragmented bones.

Common Causes for Non-union

  • Smoking
  • Diabetes
  • Obesity
  • Osteoporosis
  • Unstable fixation of fracture
  • Infection
  • Open fracture
  • Severe displacement of fracture

Common areas where non – unions can occur:

Most fractures carry a risk of no healing that results in a non-union. Non-unions can occur in any bones and are most common in the tibia (the leg bone), humerus (upper arm bone) and fifth metatarsal bone (the bone that connects the toes and the foot).

Treatment options for non-union

Treatment for nonunions differs in every patient. The doctor will determine the reason. A plan to eliminate or reduce the reason for delayed healing process is prepared. Union can also be achieved without surgery. electrical stimulation and specialized braces are some of the methods.

Treatment

Most nonunions require surgery. Surgical treatment of nonunions includes removing the scar tissue from between the fracture fragments, reducing motion of the fracture by placing metal plates, rods or pins, and a bone graft. In most cases, healing is evident within 3 months.

Surgical Treatment

Surgical treatment of nonunion Involves:

  • Building a healthy vascular area of soft tissue and bone around the fracture site.
  • This is achieved by removing any dead bone, poorly vascularized tissue or scar from the fracture area.
  • In cases of badly damaged tissue, plastic surgery is necessary to bring new healthy tissue to the fracture site.
  • To bring stability in the fractured area.
  • Rods, plates and screws for fixing. At times, “external fixator” — external pins to hold the bones above and below the fracture are used.
  • Stimulation of a fracture healing response with a bone graft.

Risks involved in a non-union surgery

Risks in a non-union surgery include neurovascular injury, infection, bleeding, and stiffness.

Preparing for the surgery

  • Any pre-operative tests that your doctors prescribe must be done immediately.
  • Avoid taking aspirin and anti-inflammatory medicines one week prior to the surgery.
  • Avoid eating or drinking anything after midnight, one night before the surgery.

What precautions to take, after the surgery?

Following a nutritious diet and exercising the non-affected muscles is required to maintain your overall health. It also helps in the recovery process. Most importantly, avoid smoking. Smoking stops fracture healing process. Avoid radiation therapy and chemotherapy systemic as all of these treatments slow the bone-healing process.

How long does it take to recover after a non-union surgery?

The length of the recovery period depends on the healing of the fracture. Your doctor will use an x-ray to find out if the fracture has fully healed. Your doctor will also provide instructions for any physical therapy and normal activities at home.

Below are the x-ray images of the previous surgery and the surgery done by our team at Sri Sri Holistic Hospital:

previous surgery and the surgery

About Doctor:

Dr. Venkat Ram Prasad Vallamshetla is one of the best orthopedic surgeon in Hyderabad. He has done his MBBS, MS Ortho (OSM), MRCS (Edin) and FRCS (Trauma & Orth) from Edinburgh. He has additionally undergone training and has worked in Birmingham for over 12 years with a specialization in Joint Replacement, arthroscopic surgery, sports injuries.

About Hospital:

Sri Sri Holistic Hospital is a leading 100 bedded multi specialty hospital in Nizampet, Kukatpally, Hyderabad. Sri Sri Holistic Hospital provides high standards of healthcare with a combination of advanced technology and state of art clinical expertise. With more than 52 Internationally experienced doctors and 400+ staff, we served at least 50,000 patients so far.