Unhealed Fractures (nonunion)

With modern treatment methods, most broken bones heal without any problems. After a fracture occurs, new bone tissue forms to connect the broken pieces. When the broken bone fails to heal it is called a "nonunion." For bone healing to happen, the bone needs adequate stability and blood supply.

Nonunions happen when the bone lacks adequate stability and/or blood flow. Factors that can increase the risk of nonunion include:

  • Use of tobacco or nicotine in any form. This includes smoking, chewing tobacco, and use of nicotine gum or patches.
  • Older age
  • Severe anemia
  • Diabetes
  • Medications including anti-inflammatory drugs such as aspirin, ibuprofen, and prednisone.
  • Infection


Patients with nonunions usually feel pain at the site of the break long after the initial pain of the fracture disappears. This pain may last months, or even years. It may be constant, or it may occur only when the broken arm or leg is used. A nonunion may be diagnosed if the doctor finds one or more of the following:

  • Persistent pain at the fracture site
  • A persistent gap with no bone spanning the fracture site
  • No progress in bone healing when repeated imaging studies are compared over several months
  • Inadequate healing in a time period that is usually enough for normal healing

Blood tests may also be used to investigate the nonunion's cause. These could show infection or another medical condition that may slow bone healing, such as anemia or diabetes.


There are nonsurgical and surgical treatments for nonunions. Our orthopedic trauma specialists will discuss the benefits and risks of treating your nonunion recommend the treatment option that is right for you. Surgical options include:

  • Bone Graft
  • Internal Fixation
  • External Fixation


Individuals heal at different rates and have many variables to consider. Your doctor will monitor your progress with repeated x-rays. It could take several weeks or months to recover.

Orthopedics and Spine