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Fracture of a bone fracture to heal is a frustrating and tragic event that can try the patience of even the most easygoing of persons. The length of time, the costs, and, especially in cases involving structurally important bones at key sites, the terrible immobility caused by fracture non-union can create a large impact on a patient’s life and livelihood.
Dr. Jones has for long had an interest in nonunion, beginning with his tenure on a university orthopedic trauma service in residency, where so many patients with these complications ended up at that time. Dr. Jones’ interest was rekindled through contact with Dr. Carl Brighton, a worldwide leader in non-union care and a developer of bone stimulation using electricity, while he works worked with Dr. Brighton in Philadelphia in a research fellowship.
The causes of fracture nonunion are many. One common source is when the soft tissues become entrapped in the fracture. Another is excessive motion between the fracture fragments. Other features often contribute, including soft bones (osteoporosis can other conditions) lack of vascularity, and advanced age. With exposure to many of these factors, fractures can lose the potential for healing. When bones fail to heal that have a key structural function, such as a long bone of a weight bearing limb through its tubular section, weight bearing is obstructed through pain and weakness. Fractures involving articular portions of the joint, which are involved in the movement and support of the joint surfaces, manifest by activity related pain and can produce arthritis in the joint over time.
The treatment of a nonunion must be very individualized, according to the site of the nonunion and the biology of the individual involved. Sometimes nonunions can be resolved without surgery, through improved fracture management, counseling a patient regarding a different approach in management, and perhaps the addition of additional therapies such as the electrical bone stimulator treatment mentioned previously. When surgery is added to these other important ingredients it, too, must be very individualized and rely on experience and the capabilities of the surgery and the ability of the patient to comply with the treatment plan, according to the risks, benefits and the nature of the postoperative recovery protocol. An informed and cooperative patient is a key ingredient to the success of fracture non-union care.
We would like to help you overcome the problems of fracture nonunion. This process begins with an assessment of the situation, that could be helped by an understanding of past treatment including x-rays if available, and summaries of any surgeries that have been carried out. We’ll require your assistance to obtain this information by your permission and sometimes, the process of assembling the information may require some courier trips to pick up CD’s containing images, and other materials that have documented your previous care. Relatives caring for a loved one who is running into lots of problems with fracture non-union, and would like us to become involved with the thought of having the relative seek our care management here in Chapel Hill, may be helped to discuss the situation with us in advance to learn what’s most feasible and efficient if care has to be transferred here. |
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