Overview
A non-union is a fracture that has stopped healing. The diagnosis rests on the exam and the X-rays together. There is lasting pain at the fracture site and motion at the fracture on exam. The X-rays show no new healing bone (callus) forming from one visit to the next. A non-union is typically declared at 6-9 months post-injury, though the timeline varies by bone and location.
Non-unions fall into two broad groups. In a hypertrophic non-union, the biology is active and forms plenty of callus, but the fracture moves too much for the callus to bridge. In an atrophic non-union, the biology has shut down. No callus forms, and the bone ends are slowly being absorbed. The group determines the treatment. Hypertrophic non-unions need stability (better fixation). Atrophic non-unions need biology (bone graft) and stability.
How the Procedure Works
The fracture site is opened, and the scar tissue that has filled the gap between the bone ends is removed. The bone ends are trimmed back to fresh, bleeding bone so healing can restart. For atrophic non-unions (where the bone has stopped trying to heal), graft is added. The gold standard is bone taken from your own hip crest, because it brings live bone-forming cells. Donated bone (allograft) and synthetic substitutes are also options, depending on the size of the gap and your overall health.
Fixation is then applied or upgraded. That may be a plate and screws, a rod through the center of the bone (an intramedullary nail), or an external frame. The choice depends on which bone is involved and the condition of the surrounding soft tissue. The goal is to give the fracture both the biology (live cells and blood supply) and the stability it needs to finally bridge across.
When to Consider Non-Union Repair
Persistent pain at a fracture site
Pain at the fracture site beyond the expected healing timeline, with X-rays showing that healing has stalled.
Failed previous fixation
Hardware failure (a broken plate or screw) with the bone slipping out of position and no sign of healing.
Treats: Non-Union / Malunion
Physicians Who Perform Non-Union Repair
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a fracture that will not heal on its own and keeps causing pain and limiting what you can do. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The main risk is that the non-union persists. This operation does not guarantee healing, though success rates are 85-95% for a first revision. Other risks include infection, pain at the hip-crest site if your own bone graft is used, hardware failure, and the general risks of anesthesia and surgery. The alternative to surgery is living with a fracture that will not heal on its own. That fracture will keep causing pain and limiting what you can do.
Frequently Asked
questions we hear in clinicHow do I know my fracture is not healing?
The diagnosis rests on the exam and the X-rays together: lasting pain at the fracture site, motion at the fracture on exam, and X-rays showing no new healing bone (callus) forming from one visit to the next. A non-union is typically declared at 6-9 months after injury, though the timeline varies by bone and location.
Why did my fracture stop healing?
Non-unions fall into two broad groups. In a hypertrophic non-union, the biology is active and forms plenty of callus, but the fracture moves too much for the callus to bridge. In an atrophic non-union, the biology has shut down: no callus forms, and the bone ends are slowly being absorbed.
Will I need a bone graft?
It depends on the type. Hypertrophic non-unions need stability (better fixation). Atrophic non-unions need biology and stability, so graft is added. The gold standard is bone from your own hip crest, because it brings live bone-forming cells; donated bone and synthetic substitutes are also options.
How likely is the repair to work?
Success rates are 85-95% for a first revision. The main risk is that the non-union persists; this operation does not guarantee healing.
What if I just live with it?
The alternative to surgery is living with a fracture that will not heal on its own. That fracture will keep causing pain and limiting what you can do.
Further Reading
External patient-education references and related OSI pages for additional background: