Yes, surgical intervention will be absolutely necessary. The goal of this surgery is to address two factors that may have failed: The biology of the bone and the mechanical instability of the fracture.
How is the need for a second orthopedic surgery determined?
It's essential to maintain constant follow-up with your specialist doctor or seek a second opinion. Between the third and fourth postoperative month, a delay in bone consolidation can be identified. If not addressed in time, this problem could evolve into nonunion (pseudoarthrosis) by the eighth or ninth month. By this stage, the bone and body have exhausted their natural biological repair capacity. At this point, the only effective solution will be to undergo surgery, as the body cannot complete the process on its own.
During your evaluation or second opinion, in addition to your physical examination, comprehensive imaging studies (X-rays or CT scans) will be requested to design a precise surgical plan and act promptly, minimizing future complications. A key finding in these studies is the presence of isolated bone calluses at the fracture ends that don't fit or connect with each other. Instead, a false joint is observed that generates instability, chronic pain and functional discomfort.
Risks and statistics: How common is this scenario?
Although the idea of a second surgery may seem overwhelming, it's the only alternative to revive the bone, reactivate bone consolidation and achieve optimal results. Nonunion affects approximately 4% of patients, especially in long bone fractures (femur, tibia and humerus). When it comes to open fractures, the risk increases to 30%, although it remains a relatively low complication.
More than surgery: A bone rescue
When patients have already faced previous surgery and a recovery process, the appearance of nonunion and a second surgery often generates concern and resistance. However, this intervention seeks to rescue the fracture focus through two approaches:
Mechanical failure (instability)
- Eliminating the false joint
- Replacing the fixation system (plates, screws or intramedullary nails)
- Milling the fracture edges to leave only vascularized tissue
- Improving compression and stability between fracture fragments
Biological failure (infected nonunion): Infections can originate from the initial fracture, during surgery, or even from distant foci (urinary, dental)
- Deep surgical cleaning of infected tissue
- Removal of implants and temporary external fixation
- Bone grafts (own or donor) to stimulate regeneration
- Prolonged antibiotic treatment (intravenous and subsequently oral)
