The human bone grows in process called osteogenesis, literally “bone beginning”. From birth until late adolescence or early adulthood, our bones grow and elongate until we reach our maximum height. However, the process of bone repair and regeneration will continue until we die. Most damaged, broken or surgically altered bones will heal themselves well, given sufficient time, blood supply and stabilization (like a plaster cast, air boot, pins, plates and screws for bone fractures or the rods, screws and plates used for spinal fusion).
Approximately 5-10% of individuals who have orthopaedic surgery or fractures will have bones that do not heal on their own or will be delayed in healing. This is called non-union and it is a complication that is dealt with by an Orthopaedic specialist. Non-union is diagnosed by taking x-rays of the area of the surgery or fracture over a period of weeks or months. The x-ray images will show if there is new bone bridging the fractured or surgical area. If no new bone exists or just a small amount has formed during the time in which total healing should have occurred, non or delayed-union should be diagnosed. The patient may also have pain in the area that persists long after the initial fracture or surgery.
Non-union is a complication which causes chronic pain, dysfunction and hampers a person’s return to work and normal activities. The most common reasons for non-union are: 1) the patient smokes; 2) they have multi-level spine fusion surgery; 3) other failed orthopaedic surgeries; 4) medical conditions, such as alcoholism, obesity or diabetes that can stunt bone healing; 5) the location of the bone in the body sometimes retards healing due to poor blood supply; or 6) infection. Sometimes an otherwise healthy person will have non-union and we won’t know the reason, like Peyton Manning, the famous NFL Quarterback. That is called idiopathic non-union.
The best way to deal with non-union is to prevent it, whenever possible. If a patient is scheduled for surgery, they should quit smoking and address whatever issues may prevent healing, before their surgery. If all factors are out of the patient’s control, they must be educated about the risks of non-union before proceeding with surgery.
There are a variety of ways to deal with non-union, some of which include surgery, internal or external fixation, bone grafting or the use of biologic bone substitute. The least invasive and only non-surgical option is a durable medical equipment device called a Bone Growth Stimulator. Bones create a mild electric field when they are healing or growing. A bone growth stimulator (BGS) sends more energy to the healing bone surface through either pulsed electromagnetic or ultrasound waves, which helps the bone heal more quickly. The Orthopaedic physicians at OSC only use external bone growth stimulators. Internal BGS units are expensive, implanted at the time of surgery and require a second surgery to remove the battery and wires of the unit from the body.
External BGS are available for almost any area of the body where a fracture or surgery has occurred. They are available as either units that connect to electrodes which deliver current to the skin over the non-healing bone or as a type of brace or belt that can either be worn or upon which a patient can recline when sitting. Typically, the BGS unit needs to be used for several hours a day over a three to nine month period to be effective and patient compliance is needed to ensure the best outcome. The units are relatively comfortable, lightweight and safe. They do not need adjustment, like TENs units. The electric current is imperceptible and causes no discomfort to the patient.
This technology is expensive and costs range from $500-$5000, depending on the manufacturer and area of the body to be treated. When ordered by an orthopaedic physician, BGS units are typically covered by most insurance carriers, but not all. You may be covered for the entire cost of the unit or there may be some out of pocket expense. Check with your insurance carrier if your physician suggests a Bone Growth Stimulator is right for you.