When Broken Bones Don't Heal: Promoting Bone Growth

Monday, December 13, 2010

ROCHESTER, Minn. — Broken bones don't always heal as expected. The December issue of Mayo Clinic Health Letter covers what hampers bone healing and extra steps that can be taken to stimulate bone growth.

A bone break that hasn't healed after six to nine months is called a nonunion fracture. Several factors can contribute to nonunion fractures. One reason can be inadequate stabilization, where the cast, plates or screws allowed the fractured bones to move. Inadequate blood supply also is a concern. Trauma near the fracture site may have damaged blood vessels and impeded blood circulation, which is critical for bone growth. Some bones, such as the upper thighbone or the small wrist bone, normally have a less robust blood supply. Infection at the fracture site, the use of nicotine, inadequate nutrition, health problems including anemia or diabetes, and some medications all can interfere with bone healing.

Several treatment options are available to spur bone growth.

• Ultrasound waves: Some patients benefit from a small device that pulses ultrasound or electromagnetic waves to stimulate healing. The device is strapped over the fracture site for 20 minutes or more, one to two times a day.
• Surgery: Surgery may be needed to modify the screws or plates that supported the fracture. A bone graft may be considered as well. A small piece of healthy bone and marrow is taken from elsewhere in the body, usually the upper pelvis. The healthy bone is placed at the fracture ends. Bone grafting is considered the gold standard for treatment of nonunion fractures. But, removing healthy bone is painful and may result in complications.
• Bone morphogenic protein (BMP): BMP is a naturally occurring chemical in the bone that stimulates bone healing. As a medication, BMP is placed on a piece of collagen mesh that is implanted over the fracture ends. More study is needed to compare the effectiveness of this treatment with a bone graft.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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