- Symptoms & Diagnosis
Fracture: Nonunion Fundamentals Every fracture carries the risk of failing to heal and resulting in a nonunion. While nonunions can occur in any bone, they are most common in the tibia, humerus, talus, and fifth metatarsal bone. Several factors contribute to a nonunion. To diagnose a nonunion, the doctor uses imaging studies that provide detailed pictures of the bone and surrounding soft tissues. Depending on which bone is involved, these tests may include x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI). Septic nonunion: If the union of the fracture is delayed due to bacterial infection to the bone is called a septic non-union fracture. Fixation elements play a key pathogenetic role in the infection. Pseudarthrosis nonunion: When a fracture with nonunion which results in a joint like motion is called as Pseudarthrosis or a “false joint”. SNAC (Scaphoid Nonunion Advanced Collapse) Prognosis natural history of disease derangement of normal carpal mechanics may lead to progressive and/or persistent wrist pain, cartilage loss, and scaphoid nonunion with advanced collapse (SNAC) with arthritic. Agents & Managers Union And Nonunion. Posted: 35 minutes ago. Looking For Talented Wayne Kids and Teens. Description: Seeking kids for commercial, theatrical and print/modeling representation.
What Are Malunion and Nonunion?
Malunion and nonunion are both problems that occur when a broken bone doesn’t heal correctly.
What is a malunion?
In a malunion, a bone heals but not in the right position. You may have never had treatment for the broken bone. Or, if you did have treatment, the bone moved before it healed. Malunion symptoms include constant pain long after treatment. If severe enough, the condition can cause a deformity and may require surgery to repair or correct it.
What is nonunion?
A nonunion is the failure of a broken bone to heal.
Where do malunion and nonunion injuries occur?
Malunion or nonunion injuries are most common in the:
- Bones between the hand and the arm
- Femoral neck (in your hip joint)
- Ankle
- Bone in your foot
Nonunion can also occur in your:
- Shoulder
- Elbow
- Forearm
- Fingers
- Knees
Malunion and nonunion can cause pain or even some loss of function.
If a malunion affects a nearby joint, it may lead to arthritis because of unusual wear on the joint.
Malunion and nonunion risk factors and causes
Some people have health problems or habits that cause their bones to fail to heal properly.
Malunion and nonunion risk factors include:
- Tobacco use
- Obesity
- Diabetes or other medical issues
Many things can cause a nonunion, such as:
- The broken bone does not have enough blood flow.
- The ends of the bone were not touching when they were stabilized (put in a cast) or corrected by surgery.
- The broken bone moved before it could heal due to improper stabilization.
Make an appointment for malunion and nonunion care
Request an appointment with a UPMC orthopaedic surgeon:
- Fill out an appointment form online.
- Call 1-866-987-6784 (ORTHO).
Learn more about malunion and nonunion injuries
From UPMC's HealthBeat Blog:
Malunion and Nonunion Symptoms and Diagnosis
Nonunion Meaning
Malunion and nonunion symptoms
Symptoms of a malunion or nonunion can include constant pain long after your fracture was treated.
Both can cause inflammation or infection because of damage to surrounding tissue.
Malunion and nonunion diagnosis
To make a malunion or nonunion diagnosis, your doctor may need to look at the bone or surrounding tissues using:
- X-rays
- MRI scans
- CT scans
If you have a nonunion, your doctor may also run blood or urine tests to look for other issues that may have caused the condition.
Make an appointment for malunion or nonunion
Request an appointment with a UPMC orthopaedic surgeon:
- Fill out an appointment form online.
- Call 1-866-987-6784 (ORTHO).
Learn more about diagnostic tests for malunion and nonunion injuries
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Malunion and Nonunion Surgery and Treatment Options
Malunion treatment
Treatment of a malunion often depends on how the injury occurred.
If a bone is misshapen enough to cause a disfigurement, you may need surgery to repair or correct it. Correcting the alignment of the bone is more important if it will cause too much stress on a joint that attaches to that bone.
Nonunion treatment
Treatment of a nonunion depends on what caused it to happen.
Nonunion Definition
Nonunion treatments are limited, but include:
- Surgery to repair the bone or to remove any infection.
- Casting or splinting (immobilization).
- Bone graft (using a piece of your own bone or a cadaver bone).
Medicines for malunion and nonunion
Your doctor might suggest taking anti-inflammation medicine to control any swelling from a malunion or nonunion.
You may also need antibiotics, if you have an infection.
Make an appointment for malunion and nonunion treatment
Request an appointment with a UPMC orthopaedic surgeon:
- Fill out an appointment form online.
- Call 1-866-987-6784 (ORTHO).
Learn more about malunion and nonunion treatments
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UPMC's HealthBeat Blog:
From our Health Library:
UPMC Patient Ed:
What is a nonunion?
Bones that do not heal after fracture are called nonunions or pseudarthrosis. Nonunions occur when a bone that is broken, either from an osteotomy (surgical bone cut) or a traumatic event, fails to heal during the course of several months. Nonunions often occur when the fracture site has either too much motion or too little blood supply for healing. These nonunions often are associated with significant deformity, pain, leg length discrepancy and occasionally infection.
Pseudarthrosis means false joint, because the unhealed area of the bone has motion like a joint. These usually occur after trauma or surgery and mostly affect adults. (A special kind of pseudarthrosis occurs in children without trauma; the bone fractures spontaneously. This is called congenital pseudarthrosis and occurs mostly in the tibia and forearm.)
How are nonunions treated?
Nonunion treatment goals are to provide a stable environment for fracture healing, improve the bone healing biology of the fracture site, and correct any associated deformities. The treatment of nonunions related to fractures or surgery depends on many factors.
Infected Nonunion
If the nonunion is infected, it usually requires removing the dead infected bone and growing back healthy bone. This can be accomplished by acutely (all at once) shortening the limb to eliminate the bone defect and then lengthening the bone at an alternative site, as described for limb lengthening. Alternatively, we can use a special technique called bone transport with which the defect is shortened at the same rate as the limb is lengthened, thereby not changing the length of the limb at any time. Both shortening with re-lengthening and bone transport result in a limb that is restored to equal length and normal alignment and that is solidly healed. It is sometimes necessary to insert a bone graft (the patient’s own bone) at the old nonunion site as part of these treatments.
Non-infected Nonunion
If the nonunion is not infected, it can be classified as stiff or mobile and as hypertrophic or atrophic. The mobility of the nonunion is assessed by examination of the bone and observing whether the unhealed area moves much in response to manipulation. This is a simple, non-painful test. If the unhealed area moves a lot, it is called mobile, whereas if it barely moves, it is called stiff. Based on radiographs, we classify nonunions regarding whether they show evidence of being hypertrophic (trying to heal) by making new bone versus whether they show no evidence of bone healing and even show indications of atrophy (withering away of the bone ends). Usually, hypertrophic nonunions are stiff and atrophic nonunions are mobile.
There are three types of treatment to consider: distraction of the nonunion, compression of the nonunion, and bone grafting of the nonunion.
- Distraction of the nonunion involves the application of an external fixator and gradual lengthening of the bone through the nonunion. This is a very successful treatment and has the advantage of not requiring any open surgery at the nonunion site; 90% achieve union without bone graft.
- Compression of the nonunion site (squeezing the bone ends together) is the other way to treat the hypertrophic stiff nonunion. It is also a good method for treatment of the hypertrophic mobile nonunion. Compression of the nonunion is achieved by the application of an external fixator or by means of internal fixation (plates, screws, and rods). Atrophic mobile nonunions usually require open treatment of the nonunion site, with removal of any dead bone and reshaping of the narrowed bone ends so that good bone contact can be achieved by compressing two horizontal surfaces. It is essential to add a bone graft to the nonunion site from cancellous bone (spongy, porous bone tissue) from one of the patient’s other bones.
- Bone grafting of the nonunion site can be combined with internal or external fixation. Bone grafting is usually avoided when there is active infection. It can be performed later as a separate procedure after the infection is eliminated.
Nonunion Fracture
Why come to the International Center for Limb Lengthening for treatment for a nonunion?
Your doctor at the International Center for Limb Lengthening will take the time to make sure you understand all of your options and then will customize your treatment to meet your specific needs. Our patients benefit from our team-centered approach with world-renowned surgeons and specialized physician assistants, nurses and physical therapists. We help patients with nonunions achieve their best possible result.
Video: Nonunions
Nonunions are bones that don’t heal. As one patient at the International Center for Limb Lengthening at the Rubin Institute for Advanced Orthopedics found out, it can be a painful, debilitating ordeal. But as you will see in this video, his nonunion was successfully treated thanks to the skill of orthopedic surgeon Dr. Janet Conway:
Chat with a Doctor About Nonunions
Our doctors hold free monthly chats on various subjects, including nonunions. Click here for more information.
Doctors Who Treat Nonunions
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