Treatment options for nonunions depend on the patient’s individual case, and may begin with an exploration of why the bone didn’t heal properly in the first place. If that reason is physiological, doctors will often try to first overcome the physiological problem so that the body can heal itself naturally.
In a few cases, orthopedic surgery is unnecessary, and doctors will try to rejoin the bones with specialized braces or electrical stimulation. However, most nonunions do require surgery that aims to: establish a healthy vascular area around the fracture site by removing dead bone or poorly vascularized tissues or scars; establish stability at the fracture site through the use of a rod, plate or screws, as well as an external fixator to secure the bones above and below the fracture; and stimulate a new healing response through the use of a bone graft.
Surgical options also depend on the type of nonunion. For hypertropic non-union fractures, for instance, surgery seeks to stabilize the fracture by compressing the two fragments. For more complex atrophic non-union fractures, the surgeon will try to hold the fracture in place while the tissue around the bone ends is removed and the avascular bone ends are hollowed out. After that, a bone graft, usually from a synthetic bone or a bone obtained from another part of the patient or a donor, is packed around the fracture area.