If your broken bone is taking longer than expected to heal, you may have heard the terms delayed union or non-union. These describe fractures where bone healing is progressing more slowly than expected or has failed to progress normally.
At Corsham Physiotherapy, Consultant Chartered Physiotherapist Simon Barnes provides specialist fracture-healing treatment for recent fractures as well as fractures where healing has been delayed.
What is a delayed union fracture?
A delayed union is a fracture that is healing, but more slowly than would normally be expected for that particular injury.
There isn’t one normal healing time for every broken bone. The expected timescale varies according to the bone involved, the nature and complexity of the fracture, its blood supply and individual factors affecting the patient.
If there is concern that your fracture may be slow to heal, your hospital or fracture clinic may arrange repeat X-rays to monitor progress.
What is a non-union fracture?
A non-union occurs when a fracture has failed to unite and is no longer showing the expected progression towards normal bone healing.
The difference between delayed union and non-union isn’t simply determined by the number of weeks since you broke the bone. Your orthopaedic team will consider the type and location of the fracture, your symptoms and changes seen on X-rays or other imaging over time.
Some bones and types of fracture are more vulnerable to problems with healing than others.
Why do some fractures take longer to heal?
Fractures can heal more slowly for a variety of reasons.
Factors that can affect bone healing include:
- the size of the gap between the fractured ends of the bone
- the position and complexity of the fracture
- blood supply to the area
- the amount of damage to the surrounding tissues
- smoking
- age and general health
- certain medications, including long-term steroid use.
The location of a fracture can also affect healing. Some areas of the skeleton have a less favourable blood supply than others, while the nature of the fracture itself can affect how readily new bone can bridge the fracture site.
More complex fractures may also have a more difficult healing process because there is greater disruption to the bone and surrounding tissues or a larger gap for new bone to bridge.
This means that two people who appear to have broken the same bone can experience quite different healing times.
How do I know if my fracture isn’t healing properly?
Delayed healing is often identified through follow-up X-rays or other imaging.
Sometimes your hospital will plan repeat imaging from the outset if the nature or location of the fracture means that healing needs to be monitored more closely.
At other times, people contact us because the fracture simply doesn’t feel as though it is progressing as expected. There may still be pain, a feeling that the area isn’t stable or sometimes unusual movement or sensations around the fracture site.
These symptoms don’t necessarily mean that you have a delayed or non-union fracture, but if you are concerned about your progress it is important to discuss this with your fracture clinic or orthopaedic team. Further imaging may be needed to establish what is happening.
Can a delayed union fracture still heal?
Yes. A delayed union means that healing is taking longer than expected, rather than that the fracture cannot heal.
The important question is why progress is slow and whether there are factors that can be addressed to give the fracture the best possible environment in which to continue healing.
Alongside appropriate orthopaedic care, this may include addressing factors such as smoking and nutrition and, in appropriate cases, considering specialist bone-stimulation treatments.
Can a non-union fracture eventually heal?
A non-union doesn’t necessarily mean that nothing further can be done, but it does require careful assessment.
Treatment will depend on why the fracture has failed to unite.
In some cases further orthopaedic treatment or surgery may be required, particularly where there is a significant gap, poor alignment, instability or another mechanical problem preventing the bone ends from uniting.
Where appropriate, specialist fracture-healing treatment may also be considered alongside ongoing orthopaedic care.
How are delayed union and non-union fractures treated?
Treatment depends on the individual fracture and the reason healing has been delayed.
Appropriate orthopaedic management remains important and may include continued immobilisation, changes to loading or activity, further investigation or, in some cases, surgery.
There may also be factors that can be addressed to support the body’s normal bone-healing processes, including smoking, nutrition and general health.
Specialist treatments intended to stimulate or support the biological processes involved in bone healing may also be considered in appropriate cases.
How can Corsham Physiotherapy help?
At Corsham Physiotherapy, we use a range of specialist electrotherapy modalities as part of our Fracture Healing service.
We have a range of specialist fracture-healing technologies available within the clinic, including LASER/photobiomodulation, LIPUS, magnetic field therapies and other specialist electrotherapy.
Different treatments may be appropriate for different fractures. The treatment selected will depend on factors including the bone involved, the nature and location of the fracture, its stage of healing and information available from your X-rays, scans or hospital reports.
This means that we don’t simply use the same machine or treatment protocol for every broken bone. Your treatment is selected according to your individual fracture and how it is progressing.
You can read more about our Specialist Fracture Healing Treatment and LASER Treatment for Fracture Healing.
Examples of delayed union fractures from Simon’s clinical practice
Simon has treated many patients whose fractures have remained slow to heal despite a prolonged period of recovery. These are two examples from his clinical practice:
Delayed union of the collarbone (clavicle)
A man in his 60s had fractured the distal end of his clavicle after falling from a ladder. He was a heavy smoker and the fracture had remained a delayed union for more than 12 months.
He underwent a course of specialist fracture-healing treatment with Simon over the following six weeks. At his subsequent hospital review, an X-ray showed that the fracture had united.
Delayed union of the fibula
A woman in her late 60s came to us with a delayed union at the distal end of her fibula. She had previously tried oxygen treatment and was being monitored by two orthopaedic surgeons, who had differing opinions about whether surgery would ultimately be required.
She underwent a course of specialist fracture-healing treatment before returning to the surgeon who had favoured continued conservative management. A subsequent X-ray showed that the fracture had united.
Every fracture is different and these individual examples cannot predict how another person’s fracture will respond to treatment. They do, however, illustrate why we often try to coordinate treatment with planned orthopaedic reviews and repeat X-rays, so that progress can be assessed objectively.
Working alongside your fracture clinic or orthopaedic team
Our fracture-healing treatment is intended to work alongside, rather than replace, appropriate orthopaedic care.
Where you already have a follow-up X-ray or fracture-clinic appointment arranged, we will often try to plan treatment around that review. This means subsequent imaging can provide useful information about how the fracture is progressing.
If further investigation or an orthopaedic opinion appears appropriate, we will discuss this with you.
Where surgery is being considered, specialist fracture treatment may sometimes form part of a conservative approach where this is clinically appropriate. However, there will be circumstances where surgery remains necessary.
What else can I do to support bone healing?
Bone healing is affected by more than the fracture itself.
As part of your treatment, we can discuss factors that may be relevant to your recovery, including nutrition, smoking, appropriate activity and loading, and aspects of your general health or medical history that may influence healing.
If there are concerns that require medical investigation rather than physiotherapy treatment, we will advise you to discuss these with your GP, fracture clinic or orthopaedic consultant.
Do I need to bring my X-rays or scans?
If you have copies or photographs of recent X-rays, scan reports or hospital letters, please bring or send them to us. They can help us understand your fracture and how healing has progressed.
Don’t worry if you don’t have access to them. Although they’re helpful, we can still assess your injury and advise whether our treatment may be appropriate.
Book an assessment for a slow-healing fracture
If your broken bone is taking longer than expected to heal, or you’ve been told that you have a delayed union or non-union fracture, please get in touch to discuss whether specialist fracture-healing treatment may be appropriate.
Fracture-healing appointments are with Simon Barnes, who has many years’ experience treating fractures and slow-healing fractures.
Our specialist fracture-healing service is based at Corsham Physiotherapy in Corsham, Wiltshire. We see patients from Chippenham, Melksham, Bath and the surrounding area, as well as patients who travel considerably further for specialist fracture treatment.
You can call us on 01249 712288, email hello@corshamphysiotherapy.co.uk or book online.