Ask Dr. Lund: Can You Fix an Unhealed Fracture?
Learn about what you can do if you suspect you have an unhealed fracture.
It’s bad enough when you suffer a fracture. Broken bones are painful, inconvenient, and slow to heal. But what happens when months go by and a fracture doesn’t seem to be getting better? Can an unhealed fracture be fixed? And what kind of specialist has the expertise to treat this bone condition? Orthopedic trauma surgeon Dr. Erik Lund specializes in treating fracture complications. He identifies factors that prevent bones from mending and explains the treatments he uses to encourage bones to heal.
Causes contributing to an unhealed fracture
“The medical term for a broken bone that doesn’t heal is nonunion,” says Dr. Lund. “It describes a bone that was treated with a cast or fixed in surgery, but did not heal. The reasons and risk factors for nonunion are varied. Some of these factors can be corrected through patient behavior, but others are not in our control.”
- Age. The bones of children and young adults heal faster. “Although nonunion can affect patients of all ages, older patients often have a higher rate of nonunion,” says Dr. Lund. “That’s because their natural regenerative healing capacity has already peaked and is in decline.”
- Nicotine use. “Smoking is a huge risk factor for nonunion,” notes Dr. Lund. “The good news is that this is a modifiable risk factor. When we think of nicotine, we think of smoking. But it’s important to point out that any type of nicotine use will impede bone healing.”
- Obesity. Extra weight puts increased strain on bones, and can contribute to nonunion.
- Diabetes. Chronic conditions that impede vascularity, like diabetes, can also contribute to nonunion.
- Vitamin D deficiency. When bones aren’t strong, it’s more difficult for them to heal. “Every fracture patient we treat is given a recommendation for vitamin D and calcium,” states Dr. Lund. “We prescribe 5,000 units of vitamin D once a day with food, because it’s a fat-soluble vitamin. That means that side effects as a result of taking extra vitamin D are very unlikely. I almost never see reports of toxicity with vitamin D. On the other hand, I know this vitamin enhances bone strength. We also prescribe calcium for patients, as long as they don’t have kidney stones or cardiac problems.
- Hormone conditions. Patients with conditions such as thyroid, parathyroid hormone, or cancer are also at higher risk of nonunion. “Irradiation treatments for these conditions can destroy bone and kill the cells,” Dr. Lund points out. “Irradiation can cause scarring on your skin and deep inside your body. Radiated bone becomes inert and inactive dead bone that won’t heal. That makes radiation treatment significant risk factor for nonunion.”
Causes contributing to a malunion
“Malunion is distinguished from nonunion because in malunion cases, the bone does heal,” explains Dr. Lund. “The problem is that the bone heals in a bad position. It might be crooked, rotated, or shorter than it was before because the fracture sheared. Like nonhealing fractures, malunion limits patient lifestyle and can cause additional issues.”
Symptoms of unhealed fractures and malunion
“Continuing pain is probably the main symptom of nonunion and malunion,” says Dr. Lund. “If someone is three, six, or twelve months out from the incidence of fracture, and continues to feel pain that prevents return to activities, that’s worrying. Weakness, inappropriate motion in the damaged limb, or other dysfunction are other indications that the bone hasn’t healed or has healed improperly. There may be visual deformity, including bumps, crookedness, or an angled or misshapen limb appearance.”
Dr. Lund explains that often, but not always, X-rays show nonunion or malunion. “When they don’t, and a fracture problem is suspected,” he adds, “I may order a CT scan to identify the problem.”
Treatment for an unhealed fracture
“If I suspect nonunion, I do a thorough medical interview and history,” says Dr. Lund. “In addition, I do a physical exam to see if there is gross motion or pain. An exam also helps to confirm a bone problem and rule out soft tissue or muscle issues. Finally, I order appropriate imaging.
“If there is clear imaging evidence of nonunion, I order a metabolic bone nonunion workup. This is a panel of labs that evaluates vitamin D, calcium, protein, thyroid, and parathyroid, and provides a nutritional study. The results give us insight about why the patient didn’t heal. When we know there is a nonunion, we’re probably going to do surgery. But we want our surgery to work. The lab panel helps us correct any modifiable metabolic abnormalities contributing to nonunion and optimize the patient’s healing capacity. This approach is based on thorough research demonstrating the importance of using lab results to tailor the treatment plan for the specific patient to maximize the surgical outcome.”
Dr. Lund notes that in some cases, lab results will prompt a patient referral to an endocrinologist or internist. “Treating an unhealed fracture is much more involved than a simple surgery,” he explains. “A nonunion is a different category of fracture. In order to maximize the reconstructive surgical outcome, all contributing factors must be considered, evaluated, and corrected.”
Treatment for malunion
“In malunion cases, there is either a gap or incorrect angle in the bone,” says Dr. Lund. “Treatment is focused on regrowing bone or rotating and straightening crookedly healed bone.” Dr. Lund explains that magnetic nails have been developed to lengthen bones that healed short. In other cases, circular and external frames are used to correct crooked bones.
“The malunion cases I focus on are more common among young patients,” notes Dr. Lund. “Older patients experience malunion too. But incorrectly healed bones frequently take a more noticeable toll on younger patients. If an older patient lives a less demanding lifestyle, the improved functional benefits that come with surgery may not be justified by the rigors of corrective surgery. When I am designing a treatment plan, there is always a balance between patient needs and surgical demands.”
Treatment timing is critical
“Typically, an unhealed fracture is not going to heal without treatment,” explains Dr. Lund. “In rare circumstances, a nonunion might heal six to twelve months after the injury. As a rule of thumb, however, an absence of healing progression and continued dysfunction for three months satisfies the diagnostic criteria for nonunion.”
Dr. Lund explains that there’s a significant advantage in treating nonunion sooner rather than later. “If you delay treatment,” he explains, “your bone continues to wear on itself, destroying bone structure. Remember, bone is strengthened through pressure—or loading. The longer the bone goes without load, the weaker and more demineralized it becomes. If nonunion prevents you from getting back to work or exercise, that has an impact on overall bone health as well as lifestyle.
“If you think you may have a bone-healing issue, I am always available to see you,” concludes Dr. Lund. “All you have to do is call our Summit scheduling number. I am passionate about supporting patients with nonunion and malunion issues. My training is focused on the most advanced techniques available to correct these problems. If you have an unhealed fracture, I want to help you heal and reclaim healthy function.”
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