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Most broken bones heal without any problems. After initial treatment, usually new bone tissue forms and connects the broken bone pieces together. However, in some patients some fractures do not heal despite medical treatment. A non-union fracture, also known as a non-healing fracture, occurs when a broken or fractured bone does not heal in the expected period of time.
The expected healing time for each bone can vary – for example, the forearm bones are expected to fully heal in 3-4 months, whereas the thigh bone can take anywhere from 6-12 months. In general, we consider the possibility of a non-union fracture if there is no sign of healing around 6-9 months after the fracture occurs.
What Causes A Non-Union Fracture?
There are a number of different causes as to why a fracture may not heal correctly. Causes for non-union fracture include:
- Infection at the site of the fracture
- Inadequate blood supply to the bone
- Separation of the ends of the bone (during surgery or after surgery)
- Inadequate surgical stabilisation of the bone
Where Can You Get A Non-Union Fracture?
While non-unions can occur in any bone, the most common bones in which non-union fractures can occur are the tibia, humerus, talus, and fifth metatarsal bone.
What Are The Symptoms Of A Non-Union Fracture?
Most patients will report the following symptoms in a non-union fracture:
- Limb or joint deformity
- Difficulty bearing weight
What Are The Types Of Non-Union Fractures?
There are generally 3 types of non-union fractures observed:
- Hypertrophic: caused by a lack of stability in the fixation used.
- Atrophic: caused by inadequate immobilisation and inadequate blood supply
- Eutrophic: caused by a combination of factors.
How Is A Non-Union Fracture Diagnosed?
As part of your hospital visit, you will undergo the following in order to diagnose a non-union fracture:
- Physical examination
- Medical history taking
- CT scan
An x-ray in particular is useful to help diagnose a non-union fracture. The x-ray will be analysed to look for any signs of union, bone instability, broken metalwork and lucency around the metalwork.
So, how can we help?
Fractures often heal well, but they can also come with treatable complications such as joint stiffness, muscle weakness, issues with tendons and damage to your nerves.
Effective physiotherapy often involves spending more time treating the injured soft tissues than the fracture itself. The doctors whose primary concern is to manage your fracture can unfortunately overlook these.
An expert musculoskeletal physiotherapy assessment can identify and treat many complications, helping to restore your normal range of movement, strength and function as quickly as possible.
Our expert physiotherapists also have the use of effective evidence based modalities such as shockwave therapy and regenerative therapy which stimulates the body’s own healing mechanism to heal tendon problems.
What should I expect from my rehabilitation?
Your treatment will depend very much on the problems identified during your initial assessment, but may include a mixture of the following:
- Soft tissue manual therapy, particularly to manage oedema, swelling and trigger points
- Scar management if you had surgery to fix the fracture
- Stretching exercises to regain joint range of movement, and optimise muscle length and tone
- Manual therapy and mobilisations to the joints to assist you in regaining good movement at the joints around the break
- Structured and progressive strengthening regime
- Balance and control work and gait (walking) re-education where appropriate
- Return to sport preparatory work and advice where required.
Our team has a well-equipped gym with state of the art equipment. This equipment enables the team to rehabilitate you faster but more importantly effectively, with the aim of reducing any down time.
For those patients that are non-weight bearing for a period of time we also have an aquatic therapy pool. This means you can continue exercising to increase muscle strength, balance, flexibility and your cardiovascular system even in the presence of any weight-bearing restrictions.
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