Non-healing fractures are called nonunions. Nonunions occur when a bone that is broken, either from an osteotomy (surgical bone cut) or a traumatic event, fails to heal during the course of several months. Nonunions often occur when the fracture site has either too much motion or too little blood supply for healing. These nonunions often are associated with significant deformity, pain, leg length discrepancy, and, occasionally, infection. Treatment goals are to provide a stable environment for fracture healing, improve the bone healing biology of the fracture site, and correct any associated deformities.
Infection of the bone is called osteomyelitis. Osteomyelitis occurs when bacteria invade the bone. The infected bone often has defects in it due to the bacteria and the inflammatory reaction of the local tissues. This infected bone is painful and frequently has a sinus tract that drains out to the skin, most often through a previous scar or wound. Infected bone has lost its blood supply. Treatment goals are to resect any dead bone and increase the blood supply to the affected area. Increasing the blood supply will allow systemic antibiotics to reach the area. Any large defects in the bone after bone resection are treated with delayed bone grafting or bone transport with an external fixator device.
Healed Fractures in Poor Alignment
A fracture that has healed in an unacceptable position is called a malunion. This unacceptable position can cause pain, early degeneration of associated joints, and difficulty walking. The most common place for a malunion is in the tibia. The treatment goal is to restore proper alignment to the fracture, which will unload associated joints and improve walking. External fixation and intramedullary devices are commonly used to restore proper alignment.
Pin Site Infection
The signs and symptoms of pin site infection are as follows.
- Redness in the same general area (compared with other areas). Do not confuse redness from infection with the red/red-purple color from scar formation.
- Warmth in the same general area (compared with other areas).
- Swelling of the area. May be hard or fluid-like.
- Drainage from the area. Characteristics may vary, such as consistency, color, and smell. (Remember that amber "tea color" drainage is normal).
- Temperature (obtained orally) of 101°F or greater. Do not take temperature reading within 2 hours of physical therapy because it may be elevated from exercising.
- Pain sometimes precedes a pin infection. It may be painful to touch around the pin site area.
At the first sign of these symptoms, begin taking antibiotics. If any of these symptoms persist for more than 48 hours, please call the ICLL team.