Bone Union Problem

Fractured bones, depending on the severity of the fracture, can take weeks to months to heal properly. A bone is “healed” when it is strong enough to allow for normal activities. A bone union problem is a bone that does not heal properly or is taking longer than expected. It might be an indication of one of the three bone union problems:

  • Delayed Union. This means that the bone is taking longer to heal than expected, but is considered to heal without the need for additional surgery.
  • Non-union. This is a condition in which the bone is not healed (united) and has very little chance that it will heal without further surgery.
  • Mal-union. This condition indicates that the bone has healed, but that it has healed in less than an optimal position. This can happen in almost any bone after fracture and occurs for several reasons.


Healing of the fractured bone depends on the severity of the fracture. Severe fractures are often called “high energy” fractures, where the bone is often broken into many pieces. Less severe fractures are called “low energy” fractures, where the bone is usually broken into two or maybe three pieces. Healing of the high energy fracture is related to the damage done to the bone and the amount of damage done to the blood supply to the bone. Blood supply is essential for the healing of all tissues in the body. Severely damaged bone also has a damaged blood supply which causes the bone to heal slowly, or never healing at all.

Blood supply to the bone may also be affected by an infection or diabetes. These may reduce the concentration of nutrients in the blood and decrease blood flow. Both factors increase the risk of a nonunion or delayed union fracture.


Symptoms for union problems can vary from minimal pain to severe limitation of activities and daily living:

  • Discomfort
  • Bruising
  • Swelling
  • Pain
  • Tenderness
  • Deformity
  • Difficulty bearing weight
  • Reduced functioning in the affected area

Potential Treatments

Orthopedics have extensive experience in treating both high and low energy fractures. Treatment involves cutting the bone, at or near the site of the original fracture. The cut or “osteotomy” is done to correct the mal-alignment. In addition, some secure methods of fixation must be used to hold the bones in the desired position including plates, rods, or an external frame with pins. Doctors may also include customized antibiotic therapies for your specific infection.
Malunions that include shortening of the bone often require some method for bone lengthening.

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