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A White Paper by Sonogen Medical, Inc.
Bone fractures typically undergo a well-orchestrated healing process involving inflammation, repair, and remodeling. However, in certain instances, this process is disrupted, leading to delayed union or nonunion of the fracture. Delayed union refers to a slower-than-expected healing trajectory, while nonunion denotes the cessation of all reparative processes without achieving bone continuity. Various medical conditions can predispose individuals to these complications, influencing both the duration and success of fracture healing. This paper explores the primary medical conditions associated with delayed and nonunion fractures, supplemented by statistical insights into their prevalence across different fracture types.
Overall, more than half a million fractures the United States progress to nonunion annually, with an overall nonunion rate ranging as high as 10%, depending on various factors such as fracture type and patient health. The likelihood of delayed union or nonunion varies depending on the fracture's anatomical location and the nature of the injury. High-energy fractures, comminuted fractures (i.e., fractures in multiple pieces), and injuries with significant soft tissue damage are at an increased risk.
The incidence of nonunion fractures varies across different bones, influenced by factors such as blood supply, mechanical stress, and patient demographics. The following table presents the approximate nonunion rates for the six major long bones, as well as the wrist and ankle:
Vascularity also plays a crucial role in fracture healing, as an adequate blood supply is essential for delivering oxygen, nutrients, and essential signaling molecules to the injury site. Following a fracture, the healing process relies on a robust vascular response to facilitate inflammation, cellular proliferation, and tissue regeneration. Blood vessels help transport osteoprogenitor cells, which differentiate into osteoblasts responsible for new bone formation. Additionally, angiogenesis—the formation of new blood vessels—is a key component of the reparative phase, ensuring that the developing bone tissue receives sufficient metabolic support. Impaired vascularity due to a number of comorbidities can also lead to delayed healing, nonunion, or compromised bone strength, including:
Delayed and nonunion fractures present significant challenges in orthopedic care, often resulting from a complex interplay of patient-specific factors and the nature of the fracture. Medical conditions such as diabetes mellitus, osteoporosis, infections, smoking, advanced age, and hypothyroidism have been identified as prominent risk factors that can impede the normal bone healing process. Understanding these associations is crucial for clinicians to develop tailored treatment strategies, optimize patient outcomes, and mitigate the risk of impaired fracture healing.
References
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2. "Bone Nonunion - StatPearls - NCBI Bookshelf."
3. "Malunion & Nonunion Fractures: What They Are & Treatment."
4. "Delayed union and nonunions: epidemiology, clinical ... - PubMed."
5. "Fracture Nonunions - Information & Treatment."
6. "Risk factors and healthcare costs associated with long bone fracture ..."
7. "Delayed Union and Nonunion: Current Concepts, Prevention ... - MDPI."
Sonogen Medical is a medical devices manufacturer, specializing in developing cutting-edge therapeutic and diagnostic ultrasound equipment. Sonogen’s products are designed to help protect, detect, and treat patients through the unique application of advanced ultrasound procedures and techniques. Sonogen’s bone fracture healing device, built on shear wave acoustics, is the first of its kind in the world.
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Bone fractures are a common medical condition, with approximately 7.9 million cases occurring annually in the United States. While the human body has a natural ability to heal fractures, approximately 8–10% of cases fail to heal properly, leading to delayed healing, nonunion, or other complications.
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