When a broken bone does not heal properly, it can cause ongoing pain, difficulty walking, and limitations in everyday activities. Some fractures take longer than expected to heal, while others stop healing altogether. This is called a nonunion.
When the bone cannot heal on its own, bone grafting may be recommended to stimulate new bone growth and help the fracture heal. The procedure involves placing bone or specialized bone graft material at the fracture site.
Depending on the severity of the injury, bone grafting may be combined with plates, screws, or other fixation devices to provide additional stability.
Understanding Bone Nonunion
A nonunion occurs when a broken bone fails to heal despite adequate time and treatment. Normally, the body forms new bone around a fracture until the two ends connect. When this process is disrupted, the fracture may remain painful and unstable.
A delayed union means the bone is healing more slowly than expected, while a nonunion means the bone has stopped progressing toward healing.
Nonunions can develop after severe fractures, significant bone loss, poor blood supply, infection, or other factors that interfere with normal bone healing. They commonly affect long bones such as the tibia (shinbone) and femur (thighbone).
Patients may experience persistent pain at the fracture site, swelling, tenderness, and difficulty putting weight on the affected limb.
How Bone Grafting Works
Bone grafting helps stimulate the body’s natural bone-healing process by placing additional bone or bone substitute material into an area where healing has failed.
There are three main types of bone grafts.
An autograft uses bone taken from another area of your own body, commonly the pelvis. Because the bone comes from your own body, there is no risk of rejection. However, it requires an additional surgical site that can cause discomfort during recovery.
An allograft uses bone obtained from a donor. This avoids the need to harvest bone from your body, although there are small risks associated with donor tissue.
Synthetic bone grafts use specially designed materials to encourage new bone growth. These may be used alone or in combination with other graft materials depending on the fracture and the amount of bone loss.
The appropriate graft depends on the location of the nonunion, the size of the bone defect, and the patient’s overall health.
Diagnosis and Evaluation
Your evaluation begins with a physical examination and review of your medical history. We assess pain, tenderness, stability, and your ability to put weight on the affected area.
X-rays are used to determine whether the fracture is healing and whether the bone has maintained proper alignment. A CT scan may provide a more detailed view of the fracture and help identify areas where bone healing has stopped. An MRI or bone scan may also be recommended in certain cases.
It is important to determine why the fracture has not healed before proceeding with surgery. Conditions such as bone infection must also be considered because they can affect the surgical approach and healing process.
Treatment Before Surgery
Not every fracture that heals slowly requires another operation. Depending on the condition of the bone, treatment may include immobilization, bracing, activity modification, and pain management.
Physical therapy may help maintain strength and mobility while the fracture heals, although weight-bearing restrictions must be followed.
If the fracture continues to show no meaningful healing or there is significant bone loss, surgery may be necessary.
The Bone Grafting Procedure
Bone grafting surgery is performed under anesthesia. The surgeon accesses the fracture site and prepares the area to encourage new bone growth. Any unhealthy or nonviable tissue may need to be removed before the graft is placed.
The bone graft material is then positioned around or within the area of the nonunion to help stimulate healing. Depending on the fracture, plates, screws, or other fixation devices may also be used to stabilize the bone and maintain proper alignment.
The procedure generally takes approximately 2 to 3 hours, depending on the complexity of the nonunion and whether additional procedures are needed.
Recovery After Surgery
Recovery depends on the location of the fracture, the amount of bone loss, and the type of graft used. Bone healing generally takes several months.
During the initial recovery period, you may need to use crutches, a walker, or a brace to avoid putting weight on the affected limb. Weight-bearing is often restricted for approximately 6 to 8 weeks, depending on the fracture and your surgeon’s instructions.
Follow-up X-rays or CT scans help monitor the healing process and determine when it is safe to gradually increase activity.
Physical therapy may begin once the bone has healed sufficiently. Rehabilitation focuses on restoring strength, flexibility, and mobility. Returning to normal activities too early can interfere with healing, so it is important to follow your surgeon’s restrictions.
Risks and Possible Complications
As with any surgery, bone grafting carries potential risks. These include infection, pain at the graft or donor site, delayed healing, failure of the graft, and fracture around the surgical site.
When bone is taken from your own body, there may be additional discomfort or complications at the donor site. In some cases, the graft may not stimulate enough new bone growth, and another procedure may be necessary.
Smoking can significantly interfere with bone healing by reducing blood flow to the bone and surrounding tissues. Avoiding smoking before and after surgery is important for improving the chances of successful healing.
Long-Term Results and Expectations
Bone grafting can help fractures that have failed to heal by providing the material and support needed for new bone formation. Many patients experience improved stability, reduced pain, and better function as the fracture heals.
However, healing is not guaranteed. The outcome depends on the severity of the original injury, the condition of the surrounding bone and soft tissues, and the patient’s overall health. Some patients may require additional procedures if the fracture does not heal as expected.
When to Seek Specialist Care
If you continue to experience pain, swelling, or difficulty putting weight on a previously fractured bone, you should be evaluated by an orthopedic specialist. Persistent symptoms may indicate delayed healing or a nonunion.
Early evaluation can help identify the reason the bone has not healed and determine whether continued nonsurgical treatment or bone grafting surgery is appropriate.
Insurance and Cost
Bone Grafting for Nonunion at Complete Orthopedics is covered by Medicare and many major insurance carriers, including Aetna, Anthem BCBS, Cigna, Empire BCBS, and UnitedHealthcare, as well as most workers’ compensation and no-fault insurance plans. Coverage depends on your individual policy, deductible, and medical necessity requirements.
Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss expected out-of-pocket costs. For additional information, visit our Insurance Information page.
