Failure of the bone to unite after a fracture is referred to as a nonunion. This can be a very frustrating problem for patients and doctors. Many patients with a non-union also suffer from depression. It is beneficial to have professional treatment for depression in addition to treating the non-union. The evaluation of a nonunion focuses on the root cause of the problem which can be classified into one of three categories: insufficient fixation (stability), insufficient biology (severe soft tissue damage) or infection. Determining the root cause is the key to getting the bone to heal. Nonunions are more common in patients who smoke so a requirement for surgical treatment of the non-union is cessation of tobacco use. Smoking increases the risk of failure to heal about 2-3 times. This is, therefore, a contraindication (reason not to do surgery) to non union repair.
Malunions result when the bone heals appropriately but in a non-anatomic position. When the malunion causes pain or limits function and all conservative efforts have proven ineffective, corrective surgery is often recommended.
Treating nonunions and malunions is a lengthy and difficult process that often takes 4-6 months to complete and typically involves corrective surgery to remove the previous implants and re-align the bone with new implants. For most nonunions the use of autogenous (the patients’ own tissue) bone graft taken from the upper portion of the hip is advised. This provides a source of stem cells that can help to heal bone. The use of growth factors such as BMP (bone morphogenic protein) is sometimes helpful for cases in which autogenous graft has failed.