When you break a bone, new bone begins to grow along the fracture, eventually closing the injury and healing completely. But when a broken bone doesn’t heal properly, it’s a nonhealing fracture or a nonunion.
What happens if a bone fracture doesn’t heal?
Understanding Broken Bones
People break bones doing pretty much everything from falling from a height to tripping on a step.
Though bones are strong living tissues that can sustain a wide range of activity and motion, they have their limits. Some people get smaller fractures that they don’t even notice. Other times, the break is far more painful and makes normal activities difficult.
A broken bone may feel like a very deep or sharp pain. Other symptoms of a broken bone include:
- Bruising
- Stiffness
- Swelling
- Warmth
- Weakness
Because there are so many bones in our bodies and so many ways to fracture them, there are a few different terms for broken bones, including:
- Closed fracture — The bone doesn’t break through the skin.
- Complete fracture — The bone breaks the bone completely into two or more pieces.
- Compound or open fracture — The bone breaks through the skin.
- Displaced fracture — The broken bone pieces no longer line up in the body.
- Nondisplaced fracture — The broken bone pieces still line up properly in the body.
- Partial fracture — The bone doesn’t break all the way through the bone.
There are also multiple ways to break a bone, such as:
- Comminuted fracture — The bone breaks into three or more pieces.
- Greenstick fracture — The bone breaks on one side but bends on the opposite side.
- Oblique fracture — The bone breaks at an angle.
- Stress fracture — This fracture hasn’t displaced and typically results from overuse or from weakened bone.
- Transverse fracture — The bone breaks in a straight line.
How Broken Bones Heal
Right after a bone breaks, your body begins to form a blood clot around the injured area. For this reason, it’s important to set the bone (or get it aligned properly) right away.
Over the next few weeks, a soft callus will form around the broken bone. This is typically when you’ll have a cast or brace on to keep the bone in place where it can continue to heal safely. Eventually, more cells and minerals will help create a hard callus that will help the bone remodel itself and grow back together.
When you’ve reached the final stage of healing the broken bone, you can probably resume normal activities. Recovery time depends on the type of break.
But sometimes, a fracture doesn’t heal properly, and further fracture care is necessary.
Understanding Nonhealing Fractures
A nonhealing fracture occurs when a broken bone doesn’t get the right amount of blood flow or stability. When that happens, the bone can’t produce new tissues to regrow naturally.
In some cases, the bone is just abnormally slow to grow back. This is a delayed union. If a bone heals in the incorrect position, it’s a malunion. When a bone doesn’t heal at all, it’s a nonunion.
Bones can break and heal in many ways. Ensuring you get the right care requires that you understand the cause of the nonhealing fracture. Some of the most common causes for a nonhealing fracture include:
- Bone infection — If bacteria enter the body during a traumatic injury, an infection can occur and disrupt the healing process. Infections can also happen during surgery.
- Inadequate blood flow — Blood flow to a broken bone is critical for cells to repair the area, but the injury can interrupt this.
- Inadequate stabilization of the bone — Stabilizing the broken bone quickly and efficiently is integral for the bone to repair itself. If the fracture is left unset or the casting process is inadequate, a nonunion may occur.
- Separation of the fractured ends of bone — When setting the bone, the pieces coming together must draw close to each other for cells to regrow. When there’s separation, the pieces aren’t close enough after stabilization to continue producing cells.
- Waiting too long to fix the fracture — If you delay seeking medical attention after a break, your bone cells may start to regrow without proper setting, which can cause malunion or nonunion. You may need a repair surgery in which a surgeon must rebreak the bone to align it properly.
How to Fix a Nonhealing Fracture
First, your doctor will examine your healing bone and perform a physical exam. Your doctor may schedule imaging, including x-rays, MRI, or CT scans. When they have a better understanding of why the bone isn’t healing correctly, they can discuss the next steps.
If imaging shows nonunion, your surgeon will discuss treatment options. These may include surgery to promote proper alignment and healing. This often involves metal internal fixation. It may also involve treatment with antibiotics if there’s an infection.
How to Prevent a Nonhealing Fracture
Seeking medical attention quickly after your injury and following your doctor’s instructions will ensure a better likelihood that your bone heals properly.
If you have concerns or questions about your healing fracture, consult your doctor so you can receive adequate care in a timely manner.