Management of non-union of long bones
Long bones are the ones that are longer than their width. Long bones category includes femora and tibiae of the leg, ulna of the forearm, metacarpals of the hands, phalanges of the fingers and collar bones.
Fractures in human bones normally heal within a period of three to four months. If the healing has not been completed within this period it can be considered as delayed union which may progress towards non union. It has been found that non union varying from 2.5% to 46% occurs based on whether the fracture is an open fracture, soft tissue fracture or vascular fracture. As per the definition of FDA, all fractures which occurred nine months back and are not showing any signs of healing for the past three months are considered as non union.
A non union of a fracture of a long bone can occur due to the following reasons:
- Excessive movement of the fractured bone
- Inadequate blood supply to the wounded area
- Unstable fixation, infection and fracture with severe displacement
- Smoking and diabetics and conventional methods of treatment are also reasons for non union
Fractures at risk for non union:
- Scaphoid bones of our palm
- Femoral neck which is the upper part of the thigh bone
- Fifth metatarsal fracture or Jones fracture which involves bones of the leg
- Open fracture in the tibia, the long bone of the leg.
Types of non union:
- Hypertrophic or elephant foot: This type of non union is vascular with abundant callus. These non unions result from inadequate immobilization or fixation
- Oligotrophic: Oligotrophic means lethal. This type of non union is vascular with no callus formation. This usually occurs after a major displacement in a fracture.
- Atropic: This type of fracture is avascular with no blood supply. Stabilization of the fracture and bone grafting are required in such cases.
Treatment for non union:
- If the ends of the bone are vascular, bone grafting will be necessary.
- Surgical treatment will be necessary to restore vascularity of the joint and for bone graft or bone graft substitute.
Authored by DR. BIREN NADKARNI