The treatments that are common today for fractures in the orthopedic specialty can treat most osteoarthritis fractures, but sometimes the healing of broken bones does not occur, which doctors call non-union.
In the following, specialist doctors will say that
What will it be like to live with a non-union fracture and what are the risks of non-union fracture and what will be the side effects of not welding bones?
what you will read next :
How does a broken bone heal?
Before we get acquainted with the non-bread fractures, it is best to know a little about normal bone healing.
As soon as your bone is fractured, the fusion process begins, the speed of fusion of different bones in the body is different.
The following factors are effective in the healing process of fractures:
- Spongy bone such as vertebrae or heels
- Tubular bones, such as the thighs and arms, are hollow in the form of an interstitial tube
For example, the fusion of these two types of bone is different.
Another factor influencing the healing process of fractures is how far apart the broken pieces of bone are, and finally, whether the fractured parts are immobile or mobile also affects the healing process of bone fractures.
Welding in the tubular bones
In long bones or tubular bones such as the thigh, the stages of fracture healing are as follows:
- Rupture of arteries around the fracture site and accumulation of blood there:
This stage is called the hematoma stage. This accumulation usually occurs in the space between the bone and the membrane on the bone; if the membrane on the bone, called the periosteum, ruptures, the bone dies within a few millimeters of the fracture.
- The membrane on the long bone is called the periosteum. There are cells between this membrane and the outer surface of the bone that will begin to multiply. In addition, cells inside the bone marrow are activated for bone formation. These two groups of cells begin to build bone in two directions to reach each other
- The primary cells mentioned above gradually differentiate and form a new bone called the callus.
- Stabilization stage
- Remodeling begins to reshape bone to its original form.
What happens to the non-union?
Sometimes the healing process described above stops and does not progress, so no bone marrow is formed that connects the two fractured heads and welds them, so what happens between two broken bones?
A fibrous tissue (such as extra flesh !!!! that forms when repairing some deep wounds and burns) builds up between the two fractured heads.
This tissue is not like a bone that is stiff, so the two broken heads will move relative to each other in this place, like a joint, but this structure is not a normal and real joint and is called a false joint.
Types of non-union
There are two types of non-union:
- When broken at both ends, bony calluses are formed, but due to the displacement of the parts relative to each other (because the broken pieces are not fixed together and have moved), these calluses have not been able to come together and although they have grown a lot, they have not been able to weld the fracture.
This non-union disorder occurs due to failure to fix broken bone pieces together.
- The second type occurs when each of the two broken heads is as thin as the tip of a pencil, which means the formation of callus, does not occur at all.
This non-union disorder occurs in cases where there is insufficient blood supply to the site.
So the following two factors are necessary for a natural welding:
- Stability of broken parts together
- Enough bloodsupply
Factors affecting non-union
The following factors can cause non-union:
- When the wrong placement is done and there is a gap between the parts
- When soft tissue such as muscle, tendon, etc. get stuck between the parts during reduction or stabilization
- Open fractures
- Fractures inside the joint space
- Pathological fractures, for example in bone metastases or bone tumors
- High age
- Severe anemia
- Consumption of nicotine, tobacco in any form
- Bone softness and weak bones
Non-union fractions cause the following problems and symptoms:
Life with non-Union fracture can be associated with pain that occurs and will continue for some time after the fracture has healed.
The most important complication and symptom of non-union fracture is pain, but this pain will have the following characteristics:
- Once the pain subsides, the original fracture begins and will continue
- The pain may be permanent
- It may occur only when a broken bone is moved
- Swelling may occur at the site of the non-union fracture
- The location of the non-union fracture can be restricted
- Swelling, tenderness (when touching or pressing), and deep pain that can sometimes be severe are some of the clinical manifestations, impaired repair, and ionization of bone fractures.
Every type of fracture in any type of bone at any age has its own healing time.
Simple X-rays, CT scans, radioisotope scans, and sometimes MRIs are used to detect non-union fracture.
Is non-Union Dangerous?
Some types of non-union fractions are not problematic and a person can live without intervention in the injured area, for example, non-union in some fractures of the wrist bones.
But aside from this, most of the non-union are problematic and need treatment, which will be determined by the orthopedic doctor according to the individual’s condition and the location of the injury, the appropriate method of surgical or non-surgical.
In which areas is non-Union more common?
All bones can be affected by non-union, but most cases of non-union fractures occur in the following areas:
- thigh bone
- Above the humerus
- Above the tibia
Fractures, pain, months and years can continue without non-union treatment.
For the treatment of non-union fracture, it is necessary to fix the fractured edges side by side.
This is possible with proper clamping and often with surgeries in which fixation is done by inserting screws, plates and nails.
There are a variety of surgical methods for treating non-union fracture, and only your orthopedist can choose the right option:
- Bone graft from the patient or autograph
- Bone graft from another person or allograph
- Use of artificial materials to replace bone
- External fixation (performed in cases where a piece of bone has fallen and been lost, for example at the scene of an accident, or in cases where the infection is in place)
- Internal fixation: parts with screws, plates, etc. are fixed from the inside.