Nonunion Fracture: Definition & Treatment

Instructor: Virginia Rawls

Virginia has a master' degree in Education and a bachelors in Sports Medicine/athletic Training

Simply put, a nonunion fracture is a bone break that does not heal properly. Complete this lesson to learn more about this type of fracture, including what causes it and how it is treated.

What Is a Nonunion Fracture?

In a perfect world, if you suspect that you have a broken a bone, you go to the doctor, and they fix it. This requires that the doctor take an X-ray to determine if there is an actual break in the bone, and if there is, the appropriate cast, splint or other medical device is placed on the affected area. After a few weeks, you go back to the doctor. They X-ray the bone again, see that it has healed, and remove your cast. You're good to go.

Unfortunately, it's more complicated than that sometimes, and the bone doesn't heal properly after being broken. When this happens, the fracture is known as a nonunion fracture. Let's look at some factors that may contribute to this type of fracture as well as nonsurgical and surgical treatment options.

Causes of a Nonunion Fracture

There are several things that can cause a fracture to heal improperly, such as:

  • The fracture was not reduced properly (to reduce a fracture is to push the broken pieces of bone back together)
  • Advanced age
  • Poor/inadequate blood supply to the bone tissue
  • Poor nutrition
  • Medication complications
  • Infection at or around the fracture site
  • Severity (the more bones that are affected and the more damage to surrounding tissue, the harder it is for a bone to heal properly)

Nonsurgical Treatment Options

If the nonunion fracture is very small, sometimes your doctor will prescribe a bone stimulator. This device is placed over the fracture and delivers small amounts of electromagnetic waves that stimulate bone healing. Depending on the bone that was fractured, treatments last anywhere from a few minutes to a few hours every day. This is a treatment that can be done in the comfort of your own home.

Another nonsurgical treatment, very similar to the bone stimulator, is the use of ultrasound. Like the bone stimulator, it promotes bone growth, but with ultrasonic waves instead of electromagnetic. Treatments usually range from 10-20 minutes in length. Depending on the type of device, this treatment can either be done at home or in a physician's office.

Surgical Treatment Options

If you have a larger nonunion fracture, or if the nonsurgical treatment does not work, you will require surgery. Surgery will be performed by an orthopedic surgeon in an operating room, and you will be placed under anesthesia for the procedure. Highlighted below are some surgical methods for reducing a nonunion fracture:

Internal Fixation

This treatment requires the surgeon to make an incision into the skin above the fracture site in order to put a fixation device directly in or on the bone. This is done to bring the bone edges together and involves either a plate and screws on the outside of the bone or a rod that goes through the shaft of the bone. After the fixation device has been surgically implanted, it cannot be seen outside the body.

External Fixation

This surgical treatment for nonunion fractures involves small incisions and the fixation device (typically a rigid stabilizing frame) being placed on top of the skin. The surgeon puts screws through the small incisions and into the fractured bone. The fixation device is visible once it is attached.

Bone Grafts

Bone grafts can be used for nonunion fractures that are too large and/or cannot be brought back together by the use of a device (internal or external fixation). Bone grafts are literally a block of bone that is cut to fit inside the fracture. Explained below are the three main types of bone grafts:

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