How Can I Get This Bone to Heal?

A nonunion is a reconstructive challenge that may have a devastating effect on a patient's quality of life. To develop an individualized treatment plan, surgeons must carefully assess several factors related to the nonunion, including the involved bone, the existing implants, the presence of infection, the soft-tissue envelope, and the function of the involved extremity, as well as the status of the patient. Essential components of an individualized treatment plan for a patient with a nonunion include management of infection (if present); optimization of the systemic and local biologic environment via management of nutritional and metabolic deficiencies, systemic disease, tobacco use, and medications that interfere with bone healing as well as via supplemental procedures, such as use of biologics or bone grafting; and achievement of mechanical stability via internal or external fixation that allows for early functional active range of motion and weight bearing. The goal in the management of nonunion is to maximize the likelihood of healing in the most expedient manner without further complications.