Non-Healing Bones, Institute for Limb Preservation
When a bone fractures (breaks) and does not go on to heal a non-union has occurred. The most common causes of non-union are:
- bone loss
- metal hardware (fixation) that is not strong enough to stabilize the fracture
- biologic imbalances in the bone and surrounding tissue
Non-union can also be caused by what are termed "host factors." This includes the patient's overall health, nutritional status, and certain medications they may be taking.
The diagnosis of a non-union is made through a careful history and examination of the patient and by looking at x-rays. Sometimes special x-rays, called tomograms, are obtained to determine if the fracture has healed. Some non-unions are painful, and some become infected.
The treatment begins with determining, if possible, the cause of the non-union, and taking measures to correct the cause. The exact cause of the non-union is not always evident, and many times it is a combination of factors. If there is an infection - osteomyelitis - the infection must be treated. If the problem is that the metal hardware is not sufficiently holding the bone together, a different type of hardware may be needed to fix the fracture. This may be internal (inside) or external (outside). External fixation is outside the body, where a metal frame is placed with pins that tract from the frame through the skin and into the bone. This stabilizes the fracture while it heals. Patients can walk with these external fixators on, though they may require the assistance of crutches or a cane.
The patient is an integral part in helping these non-unions heal. Smoking delays bone healing tremendously, so someone who smokes and is having a bone healing problem should quit smoking. Vitamin C and Vitamin E stimulate bone formation so taking 500 mg of Vitamin C twice a day, along with Vitamin E, 400 IU daily help the process. The patient and family must remember that non-unions by nature are slow to heal, and may require several different approaches or combined modalities.