Proximal Femoral non union treated with a corrective osteotomy and plate fixation

Non Union

Malunion

Failure of the bone to unite after a fracture is referred to as a non union. This can be a very frustrating problem for patients and doctors. Most patients that I treat with a non-union also suffer from depression and I usually recommend they have professional treatment of their depression in addition to treating the non-union.  My evaluation of non-unions focuses on the root cause of the problem which is classified in one of three categories: insufficient fixation (stability), insufficient biology (severe soft tissue damage) or infection.  Determining the root cause is the key to getting the bone to heal. Smoking is much more common in patients with non-unions and a requirement for surgical treatment of the non-union is cessation of tobacco use. If a patient is smoking, their risk of failure to heal is about 2-3 times higher and I consider this a contraindication (reason not to do surgery) to non union repair.

Treating non-unions and malunions is a lengthy and difficult process that often takes 4-6 months to complete.  The often involves corrective surgery to remove the previous implants and re-align the bone with new implants.  For most non unions I recommend the use of autogenous (the patients' own tissue) bone graft taken from the upper portion of the hip.  This provides a source of "pluri-potential" stem cells that can form bone.  The use of growth factors such as BMP (bone morphogenic protiens) is sometimes helpful for cases in which autogenous graft has failed.