Emphasizing that smoking delays bone union, experts point out that factors such as nutrition and diabetes are also effective in delaying the union. Experts recommend benefiting from sun rays rich in vitamin D and foods rich in calcium and protein for bone health.
Üsküdar University NPISTANBUL Hospital Orthopedics and Traumatology Specialist Prof. Dr. Mehmet Kerem Canbora said that there are many factors that delay or cause non-union in bones.
If the bone has not united in 5.5 - 6 months, surgical intervention is required
Stating that fractures occur very easily but their union is a complex process, Prof. Dr. Mehmet Kerem Canbora said, "We fuse most of the fractures surgically or non-surgically. Years ago, the expected time for the fracture to union was a period of 9 months. In a period of 6-9 months, if we could not get the signs of union in the film, radiology or clinically, we could say that it was not fusing. Today, that period has shortened by a few months. We can give an example from the most commonly fractured tibia. It makes no difference whether we treat a closed fracture with a surgical operation or a cast in a small child. In this process, there is a predicted loading time with circulation monitoring and X-ray monitoring. We estimate it by looking at the fracture, it is not very standard, but we can talk about a period of about 6-8 weeks. First we press on it slowly and then we apply full load. The expected time for the union of an adult tibia is 2 - 2.5 months, if it has extended to 3 - 4 months and there is no indication of union on x-ray, closer follow-up is required. If there is no evidence of union in at least 3 of the 4 x-rays taken, we can consider that the union is delayed if the time has been exceeded. If 5.5 - 6 months have passed and it is still non-union, it is necessary to plan surgical intervention in order to prevent the formation of a false joint by considering the infection."
There is a risk of infection in open fractures!
Canbora stated that they evaluate the delayed union in fractures more positively than problematic unions or no union at all and continued his words as follows:
"There is an important difference between delayed union and nonunion. In delayed union, that process is ongoing, that is, we can make progress by helping that union, but in nonunion, this is not a process that continues by itself. For example, there may be open fractures where the fracture line is in contact with air. In order for the fracture ends to come into contact with the air, they need to break through the skin. Compared to closed fractures, the follow-up, approach and processes are different. In open fractures, there is definitely a risk of infection that delays the union process, inhibits metabolism, factors in the union process and increases the movement at the fracture site. In open fractures, the surrounding soft tissue is very damaged due to the fragmentation of the fracture line and the high energy trauma outside. When these negative results come together, it is seen that the problem of nonunion and infection in open fractures is much higher than in closed fractures."
Soft tissue around the fracture is important
Pointing out that the hematon hormone, which provides union in fractures, is of golden value and that this hormone is lost in open fractures, Canbora said, "Patients lose all growth factors and the hematoma hormone that will initiate the union of the bone when the fracture is open. In open fractures, some pathogens enter, some of the fracture ends may be lost, there may be nerve damage and worse, the soft tissue cover around it may be disrupted. At best, even if the soft tissue cover is not lost, it is damaged. Years ago, open fractures were classified based on the fracture alone, but in recent years, they are now also classified according to soft tissue damage. The surrounding soft tissue damage is also important now, and if the damage is too much, it should be treated like an open fracture. It is not necessary that only the fracture ends are visible and in contact with air. It is part of the treatment to restore the surrounding soft tissue cover by transferring it from elsewhere or using existing tissue, covering it with skin and providing blood supply. In order for the union process to begin, vascularization must occur in that area, stem cells and mediators must be able to reach. Open fractures are the most troublesome and complication-causing condition that orthopedists deal with the most due to the high risk of infection. Open fractures are an important problem that can lead to limb loss in periods of 2 to 3 months and can negatively affect the whole metabolism."
Smoking delays the union of the broken bone
Canbora pointed out that nutrition, diabetes and cigarette addiction delay the union and continued his words as follows:
"There are very important factors in fracture union such as macrophages, some chemical mediators and smoking suppresses all of these. It has been proven that bone union is delayed in smoking addiction. We can also say that smoking is an important cause of nonunion. Fracture union is a very complex process, there are cells and stem cells that are important in union. As each cigarette smoked increases, nicotine inhibits some of the necessary activations of stem cells during bone union. In addition to smoking addiction, osteoporosis is important over a certain age. Especially in post-menopausal women, estrogen is withdrawn and osteoporosis slows down metabolism. Sometimes even some painkillers can delay the union. Specialists in fractures need to question the painkillers used, smoking addictions and manage the process."
Some fractures stop growth in children
Stating that non-union of bone fractures in children is very difficult, Canbora said, "Most bones in children fuse, but the proximity of the fracture to the growth line is very important. We do not encounter nonunion very often in children, but we can often see that growth stops. We assume that the closer the fracture is to the growth line, the more growth will be affected, especially in long bones. In general, we need to be very careful because it can lead to malalignment, distortions and shortness. When growth stops, one side may be shorter than the other side. In this case, we have to slow down the growth of the other side. Since it is a child, it should be taken seriously and parents should pay close attention. Although we prefer to heal without surgery first, sometimes not operating can harm the patient. Surgical techniques have advanced and implant technology has also improved a lot. Although surgery is not always necessary, sometimes it can be very necessary."
Vitamin D is essential for bone health!
Pointing out that nutrition, vitamin D, exercises and lifestyle are important for bone health, Canbora said, "Vitamin D is one of the rare hormones that must be taken from outside in the body and we can get it mostly from sunlight. Along with regular exercise, nutrition and hormonal factors also come to the fore. Calcium and protein-rich foods should be consumed. Protein deficiency is one of the most important causes of boiling. Protein, fat and other balances should be well maintained. If there is an extra disease such as diabetes, it must be kept under control."