Non-Healing Fractures Benefit from Experienced Team at UMMC

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Broken bones that won’t mend are an uncommon problem. But the University of Maryland Medical Center boasts rich expertise in treating non-healing fractures, owing to its renowned reputation in the fields of shock trauma and orthopaedics and an interdisciplinary team that draws hundreds of these cases to UMMC each year.

Typically, appropriate treatment of a broken bone will result in new bone tissue forming to connect the broken ends. But some fractures won’t heal without extreme intervention, either because of the force of the bone-breaking injury or certain risk factors — such as inadequate nutrition or blood supply — that impede normal healing.

Known medically as “non-unions,” these fractures “fail to demonstrate clinical progression or radiographic progression to healing over a series of follow-up X-rays,” explains orthopaedic surgeon Marcus Sciadini, M.D., an associate professor of orthopaedics at the University of Maryland School of Medicine. Between 2% and 5% of the 8,000 or so gross fractures treated at UMMC and the R Adams Cowley Shock Trauma Center annually fall under this definition, he says, impacting these patients’ lives far more than the initial impact that broke their bones.

“It can be devastating to deal with,” says Dr. Sciadini, also interim chair of the Department of Orthopaedics at UMMC’s Midtown Campus. “It’s very difficult to get that patient back to 100% of what their life was like before.”

Certain Fractures, Patients at Greater Risk

Depending on the location of a broken bone, typical healing time averages between six weeks and six months, Dr. Sciadini notes. But certain scenarios make it far more likely that the fracture won’t heal despite initial treatment. These include:

  • High-energy trauma causing the break, including motorcycle and auto accidents or falls from high places
  • Co-existing medical conditions such as diabetes or peripheral vascular disease, which impede blood flow
  • Heavy smoking
  • Infection near the fracture
  • Low vitamin D levels and other nutritional factors affecting bone health

With high-velocity fractures such as those resulting from car crashes, widespread soft-tissue damage surrounding the break can create instability around the bone, inhibiting its ability to heal properly. The trauma can also lead to reduced blood flow to the area and conditions ripe for potential infection, Dr. Sciadini says.

“Non-unions are probably more dependent on the mechanism of injury and soft-tissue injury than any specific patient demographic,” he adds. “But there are some types of patients more prone to non-unions . . . so there are definitely certain fracture types and patient groups at greater risk.”

Treatment Individualized to Each Patient

UMMC orthopaedic specialists individualize treatment to each patient in order to coax their broken bones to finally fuse together. Treatments can involve both surgical and non-surgical procedures encompassing, among other measures, a combination of rods, plates and screws; bone grafts or transfers; muscle flaps or transfers; or external fixation with hardware or casts.

Regardless of the complexity of treatment, a team approach is often required to respond to all factors that led to the non-healing fracture. In this regard, UMMC’s faculty and staff are set apart, he says. In addition to orthopaedic surgeons, physicians such as plastic surgeons and upper extremity specialists often contribute to a patient’s recovery.

“I think our biggest strength is that we have a huge volume of complex injuries we treat acutely,” Dr. Sciadini says. “We see a fair number of non-unions come out of that because of the complexity of the fractures we take care of in the first place. We have an extremely well-qualified set of people who are all well-versed in the multitude of surgical procedures we need to have in our armamentarium to deal with these issues.”

Appointments to see Dr. Sciadini can be made by calling 410-448-6400.

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