Foot & Ankle Surgery
FOOT SURGERY ANKLE CHARCOT DROPFOOT BROKEN BONE FRACTURE CMT INFECTION DIABETIC ULCER WOUND CARE

NONUNION

Nonunion is what we call when bones do not heal, delayed union is a term used when the bones are not healing as fast as they should. Malunion is where they healed in the wrong position. And finally an infected nonunion is exactly that - and a clinically challenging situation.

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 NONUNION or DELAYED UNION

A serious complication of bone surgery or trauma is nonunion, simply meaning that the bone ends are not able to heal together. This may be due to surgical technique, the general health of the patient, or due to the local damage of the tissues in the surgical area. The FDA defines a nonunion as a fracture that is over 9 months old and that has not shown radiographic signs of progression toward healing for 3 consecutive months. Actually the union rates for different bones in the body can vary dramatically a mid tibial shaft fracture heals much slower than a calcaneal fracture. Nevertheless we treat a possible nonunion before many even recognize that there is an impending problem. 

We use advanced imaging, Bone Scan technology, MRI 3D reconstruction as well at CT scan and Traditional Xray and ultrasound to make an early diagnosis. We then follow a specially prepared algorithm monitoring the patients overall health, vitamin deficiency, Tobacco habits (which are known to slow healing time) as well as occult disease such as osteomalacia, collagen vascular disease  and Hyperparathyroidism. We work closely with the patients own medical doctor and any specialists if necessary. 

Nonunions rarely heal without intervention, but this intervention can be surgical and nonsurgical conservative in nature. We are conducting research with electrical bone stimulation and ultrasound bone stimulation for bone healing. Also we perform some less know surgical techniques such as parafocal osteotomy to manipulate a human body vascular response to surgery, we used the bloodless technique of ilizarov compression distraction. Dr. David Gitlin is also one of few foot and ankle specialists who work with regenerative medicine modalities such as PRP injection, BMP infusion and stem cell therapy.

The most common nonunions and delayed unions we generally see in practice are in bunion osteotomy areas where the bone was cut and the blood flow was insufficient to heal it, also ankle fusions have a high nonunion rate. Another very high rate of nonunion we see is in fractures of the fifth metatarsal, that is the bone on the outside of the foot.