Bone Fractures and Non-union
How fractures heal, what influences healing, and fractures that fail to unite.
Bone is one of the few tissues that can rebuild itself. With appropriate treatment and sufficient time, most fractures unite. In some cases, however, the fracture line does not join within the expected period — generally six to nine months — a situation called non-union.
How a Fracture Heals
Healing proceeds in successive stages: bleeding and clot formation at the fracture site, an inflammatory response, formation of soft callus, mineralisation of that tissue and finally remodelling of the bone over years. Throughout this process, immobility of the fracture and good blood supply are decisive.
What Affects Healing
- Smoking: among the most frequently reported factors that impair bone healing
- Diabetes and inadequate nutrition
- Disruption of the blood supply at the fracture site by the injury itself
- A gap between the fracture ends or insufficient fixation
- Infection
- Long-term use of certain medications
Non-union and Its Treatment
Signs of non-union include persistent pain at the fracture site, discomfort on weight-bearing, and a fracture line still visible on X-rays months later. Assessment examines the adequacy of fixation, the blood supply and whether infection is present.
Treatment is directed at the cause: revision of fixation, freshening of the fracture ends, addition of bone graft and treatment of any infection. Stopping smoking and correcting nutritional deficiencies are integral parts of the process — see trauma and fracture surgery.
If months have passed since your fracture treatment and pain persists, if you cannot bear weight, or if follow-up X-rays show no union, arrange an assessment.
Frequently Asked Questions
How many weeks does a fracture take to heal?
The time depends on the bone, the fracture pattern and the patient's age. It is measured in weeks in children and longer in adults; follow-up X-rays determine union.
Should metalwork be removed?
Not in every patient. Implants that cause discomfort, become prominent under the skin or limit function may be removed once union is complete.
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