Causes and risk factors
Union of bone takes place in several stages such as – hematoma formation, inflammation, and cellular proliferation, callus formation, consolidation, and remodeling. For healing, factors required are – stability, blood supply, and nutrition. Delayed union can occur due to inadequate blood supply to the fractured bone, infection at the fracture site, incorrect splintage, intact fellow bone, etc. Risk factors for delayed union of bones include open fractures, high energy fractures with bone devitalization, severe soft tissue injury, bone loss, and advanced age. Systemic risk factors include malnutrition, smoking, NSAIDs, chronic alcoholism, and diseases like diabetes. Classification of delayed union is as follows – hypertrophic, oligotrophic, atrophic, and pseudoarthrosis. In hypertrophic union, callus formation is either abundant [elephant’s foot], less abundant [horse’s hoof]. It needs stability to consolidate. In oligotrophic union, there is some minimal callus formation. Atrophic includes absence of callus formation. Pseudoarthrosis includes adequate vascularity with instability and false joint formation.
Clinical presentation
Patient presents with pain and tenderness at the site of fracture. Bone may still be mobile when stressed.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. X-ray will reveal the fracture to be still evident or in a state of incomplete healing.
Treatment
Continuation of the previous treatment of fracture is required. Fracture cast is replaced if necessary. Traction may be reduced. Functional bracing of the bone may be done to promote bone union. Additional no operative treatment includes electrical stimulation, extracorporeal shock wave therapy, ultrasound. Operative treatment includes – debridement and hardware removal, plate osteosynthesis, intramedullary nailing, and external fixation. Internal fixation is done if the fracture does not heal within 6 months. Further treatment consists of Bone grafting.
Other Modes of treatment
The other modes of treatment can also be effective in treating delayed union of fracture.
Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating delayed union of fracture.
