| Unhealed Fractures |
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| Wednesday, 18 July 2007 | |
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Non-union of fractures and bone healing problems When a bone fractures (breaks) and does not go on to heal a non-union has occured. The most common causes of non-union are: infection, bone loss, metal hardware (fixation) that is not strong enough to stabilize the fracture, and 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 - osteomylelitis - 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 indicated. 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. One type of External fixator is called an Ilizarov device after a Russian physician who invented it. This fixator is composed of multiple metal rings, metal rods, and thin pins which form a kind of cylinder and wraps completely around the extremity. It is typically used on the lower leg, but can be employed around the thigh, and occasionally around the arm. There are even "mini" Ilizarovs that can be placed on fingers. As you can imagine, the proper use of this apparatus requires a great degree of specialized training to become skilled at its use. The orthopaedic surgeons of The Denver Clinic for Extremities at Risk have an expertise in the use and application of the Ilizarov. The patient is an integral part in helping these non-unions heal. If they are smokers, they should quit because smoking delays bone healing tremendously. The other things a patient can do is to take Vitamin C, 500 mg twice a day, along with Vitamin E, 400 IU daily. These vitamins may assist with bone healing. The patient and family must remember: Non-unions by nature are slow to heal, and may require several different approaches or combined modalities. |
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| Last Updated ( Friday, 01 February 2008 ) |
