What is Non-union?
Non-union is the failure of a broken or fractured bone to heal properly even after appropriate treatment.
What is Non-union Surgery of the Elbow?
Non-union surgery of the elbow is an operation performed to restore a broken or fractured bone in your elbow joint that has failed to heal even after appropriate treatment.
Causes of Non-union
Non-union usually occurs when the fractured bone lacks adequate blood supply or stability or both. Additionally, an infection at the site of the fracture or parting of the bone’s broken ends may also result in non-union.
Some of the other factors that can increase the risk of non-union in the elbow include:
- Older age
- Poor nutrition
- Severe anaemia
- Medical conditions like diabetes
- Use of tobacco or nicotine products
- Medications such as anti-inflammatory drugs
Finding the causes of a non-union is very important in choosing the appropriate surgery.
Symptoms of Non-union
Persistent pain at the fracture site long after surgical or non-surgical treatment and following disappearance of the initial fracture pain is the major symptom of a non-union fracture. The pain due to non-union of the elbow may:
- Last months or years
- Become constant
- Occur only when the elbow is used
Diagnosis of Non-union
Diagnosis for non-union may become necessary if your doctor finds any of the following:
- No improvement in bone healing
- Inadequate and very slow healing
- Constant gap with no bone at the fracture site
The doctor will use imaging studies or tests such as an X-ray or a CT scan or an MRI to diagnose a non-union in your elbow. These studies or tests will help the doctor to see the bone images, the progress of healing and the possible bone gap at the fracture site.
What are the Nonoperative Options?
The most common nonoperative option is the use of a bone stimulator device, which delivers ultrasonic or pulsed electromagnetic waves to the fractured site to stimulate healing. This treatment can be effective if used for a specific period every day.
The other option is fracture brace immobilisation to ensure the stability of the fracture during the healing process.
What are the Operative Options?
Surgery is the next option when nonoperative methods failed. The operative options include:
- Bone grafting
- Internal fixation
- External fixation
Bone grafting involves placing additional bone around the area of the non-union. A Bone graft provides scaffolding, fresh bone cells and naturally occurring products for bone healing. Occasionally, bone graft substitutes may also be used to stimulate healing.
However, bone graft alone may not provide firmness to the fracture site. The procedure may require a follow up with internal or external fixation wherein the doctor may use metal plates or frames and screws to improve the stability of the fracture site.
More than one option may be appropriate for healing. Therefore, the doctor may use a combination of all to improve the outcome.
What Happens After Your Surgery?
Immediately after the surgery, your elbow may be fitted with a hinged brace locked at 90 degrees of flexion, sometimes along with a well-padded splint.
Your rehab may start 4 to 6 weeks after the surgery and begin with range of motion exercises under the supervision of a physiotherapist. However, below 90 degrees flexion rule needs to be maintained until bone healing in the elbow is achieved.