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The reasons for delayed healing after bone plate fixation can be summarized as the following multiple factors:
1. Local factors
Insufficient stability of the fracture end: If there is slight movement at the fracture end after bone plate fixation, it will disrupt the formation of new callus, resulting in delayed healing. For example, loose bone plate screws, unreliable fixation, or complex fracture types (such as comminuted fractures) lead to difficult fixation.
Disruption of blood supply at the fracture site: Surgical operations may damage the blood vessels around the fracture site, leading to insufficient local blood supply and affecting the activity of bone cells and osteoblasts. For example, when there is a fracture of the diaphysis, excessive periosteum dissection can damage the vascular network of the periosteum, thereby affecting the healing of the fracture.
Infection: Postoperative wound infection or deep infection can lead to the persistence of local inflammatory response, damage bone tissue and hinder healing. Infection may also cause osteomyelitis, further increasing the risk of nonunion of bones.
Soft tissue embedding: If there is soft tissue (such as muscle or fascia) embedding between the fracture ends, it will form a mechanical barrier, preventing the callus from crossing the fracture ends and resulting in delayed healing.
2. Systemic factors
Nutritional status: Deficiencies of protein, vitamins (such as vitamin C and vitamin D), and minerals (such as calcium and phosphorus) can affect bone metabolism and callus formation. For instance, patients with long-term malnutrition or those suffering from consumptive diseases such as tumors and tuberculosis may experience a significantly slower rate of fracture healing.
Metabolic diseases: Diseases such as diabetes, thyroid dysfunction, and osteoporosis can affect bone metabolism, leading to delayed fracture healing. For example, the hyperglycemic state of diabetic patients can inhibit the activity of osteoblasts and delay fracture healing.
Age factor: In the elderly, the bone metabolic capacity declines, the activity of osteoblasts decreases, and the healing speed of fractures is slower. In addition, the elderly often have osteoporosis, which further increases the difficulty of healing.
Smoking and excessive drinking: Nicotine in tobacco constricts blood vessels and reduces blood supply to the fracture ends. Alcohol can interfere with bone metabolism and affect the formation of callus. Patients who smoke and drink alcohol excessively for a long time have a higher risk of delayed fracture healing.
3. Treatment-related factors
Improper surgical operation: During the operation, if the periosteum is overly stripped, the surrounding soft tissues are damaged, or the necrotic tissue at the fracture end is not completely removed, it may affect fracture healing. For example, improper placement of the bone plate or excessive density of screws may lead to stress occlusion and affect the formation of callus.
Improper selection of internal fixators: The strength and stiffness of the internal fixator do not match the type of fracture, which may lead to fixation failure or micro-movement at the fracture end. For instance, for patients with osteoporosis, if ordinary screws are used for fixation, the screws may become loose due to insufficient holding force.
Unreasonable rehabilitation training: Premature weight-bearing after surgery or improper rehabilitation training may lead to displacement of the fracture end or loosening of the internal fixation device, affecting healing. On the contrary, if immobilization is carried out for a long time, it may lead to joint stiffness and muscle atrophy, indirectly affecting the healing of fractures.
4. Drug factors
Non-steroidal anti-inflammatory drugs (NSAIDs) : Long-term use of NSAIDs may inhibit the synthesis of prostaglandins, and prostaglandins have a promoting effect on bone metabolism, thus possibly delaying fracture healing.
Glucocorticoids: Long-term use of glucocorticoids can inhibit the activity of osteoblasts, increase bone resorption, and lead to osteoporosis and delayed fracture healing.
Anticoagulant drugs: Some anticoagulant drugs may increase the risk of postoperative bleeding, leading to local hematoma formation and affecting fracture healing.
5. Other factors
Genetic factors: Some patients may have hereditary bone metabolism abnormalities, leading to a decline in fracture healing ability. For instance, patients with certain hereditary bone diseases (such as osteogenesis imperfecta) have a slower rate of fracture healing.
Psychological factors: Long-term negative emotions such as anxiety and depression may affect the endocrine and immune systems, thereby indirectly influencing fracture healing.
Underlying diseases, such as chronic kidney disease and liver disease, may affect the metabolism and absorption of nutrients, leading to delayed fracture healing.