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The treatment methods for nonunion after bone plate fixation mainly include the following:
Conservative treatment
Drug therapy: Drugs that promote bone growth, such as bone peptide injection, can be used, which can regulate bone metabolism and induce the formation of new bone. At the same time, calcium supplements and vitamin D are taken to provide sufficient calcium for bone healing and enhance bone strength. For infectious nonunion of bone, antibiotic treatment can be used to eliminate the infection and create favorable conditions for fracture healing.
Physical therapy: Extracorporeal shock wave therapy uses high-energy shock waves to stimulate the fracture site, activate osteoblasts, promote local blood circulation, improve blood supply at the fracture site, and accelerate the bone healing process. Low-intensity pulsed ultrasound therapy stimulates the proliferation and differentiation of bone cells and promotes fracture healing through the mechanical and thermal effects of ultrasound. Electromagnetic field therapy utilizes specific electromagnetic fields to regulate the metabolic activities of bone cells and enhance the repair capacity of bone tissue.
Rehabilitation training: Under the guidance of a doctor, performing moderate muscle contraction exercises, such as quadriceps contraction exercises, can promote blood circulation, enhance muscle strength, prevent muscle atrophy, and facilitate fracture healing.
Surgical treatment:
Bone grafting surgery: Autologous bone or artificial bone materials are implanted into the non-union site of the fracture to provide bone conduction and bone induction, promote the formation of new bone, and connect the fracture ends. For nonunion of bones with large defects, bone transplantation surgery is necessary.
Internal fixation surgery: By using instruments such as steel plates, screws, and intramedullary screws, the fracture site is firmly fixed to ensure close contact at the fracture ends, reduce micro-movement, and provide a stable environment for fracture healing. For nonunion of bones with unstable fracture ends or clear fracture lines, internal fixation surgery is an effective treatment method. If the original internal fixator is loose or broken, the internal fixator needs to be replaced to re-stabilize the fracture site.
External fixation surgery: External fixation surgery is suitable for nonunion near joints or bone deformities. It stabilizes the fracture site through an external fixation stent. By evenly distributing the load, the external fixation stent reduces the risk of soft tissue injury, provides physical protection for the fracture, and is conducive to controlling infection and promoting healing.
Biological therapy
Autologous red bone marrow transplantation: Autologous red bone marrow contains hematopoietic stem cells and bone marrow mesenchymal stem cells. The latter has the potential for osteoblast differentiation, can produce various factors that promote endogenous repair processes, and can also differentiate into osteoblasts to accelerate bone repair.
Platelet-rich plasma (PRP) injection: PRP contains a large amount of growth factors, such as platelet-derived growth factor, transforming growth factor, etc. The interaction among various growth factors can stimulate and accelerate the healing of fractures and soft tissues.