Problem fractures are fractured bones that do not heal properly. These problem fractures can cause pain and limited mobility or movement for months or even years if they do not heal properly. There are two main types of problem fractures: non-union fractures and mal-union fractures. Non-union fractures are fractured bones that fail to heal properly within usually a 6-9-month time frame. Mal-union fractures are fractured bones that heal in an imperfect or faulty position. These mal-union fractures often result in crooked, shortened, or rotated limbs.
Symptoms
Prolonged pain at injury site
Deformity
Altered gait if lower body fracture
Pain in other areas due to altered mechanics
Instability of area
Causes
Inadequate stability of the bone while trying to heal
Poor blood flow to the fracture site (non-union)
Bone shifting during healing process (mal-union)
Another injury occurring after the initial fracture injury
Risk Factors (of non-union fractures)
Smoking or nicotine use
Older age
Severe anemia
Diabetes
Low vitamin D level
Hypothyroidism
Poor nutrition
Anti-inflammatory use
Infection
Complicated fracture
Prevention
Have fracture treated immediately after injury and go for regular check-ups to make sure the fracture is healing properly
Maintain good health and good nutrition
Diagnosis
Physician exam finding gap at fracture site and no progress in bone healing over several months (non-union) or faulty alignment in bone healing (mal-union). Physician should also check range of motion, symmetry of limbs, and gait.
Blood test to check for an infection or a medical condition such as anemia or diabetes (non-union)
X-ray
CT
MRI
Scanogram
Treatment Options
Non-surgical:
Bone stimulator machine (non-union)
Shoe lift or bracing (mal-union)
Surgical:
Bone graft
Osteotomy to cut and realign bones (mal-union) or to remove non-healing portion of bone to make way for new healthy bone with good blood supply (non-union)
Internal or external fixation to stabilize the bone, improve function, and improve blood flow to area to facilitate healing
Distraction osteogenesis to elongate bone using internal lengthening rod or external frame