1
Too Much Motion
Loose hardware, inadequate fixation, bone loss or an unstable fracture pattern can allow repeated movement that prevents union.
Revision fracture second opinions
Fracture Nonunion & Malunion Treatment in Atlanta
A fracture that still hurts, has stopped progressing or healed in the wrong position deserves a careful explanation—not simply more waiting.
Why is the fracture not healing?
We evaluate the mechanical stability, alignment, blood supply, infection risk and patient factors that may be preventing successful bone healing.
Independent imaging review
Mechanical and biologic evaluation
Bone-stimulator assessment
Revision fracture surgery
Two different healing problems
Nonunion Versus Malunion
Both can cause persistent pain and poor function, but they require different solutions.
Fracture Nonunion
A nonunion is a fracture that has not made the expected progress toward solid healing. Patients may continue to have pain, motion at the fracture site or broken and loose hardware.
The first step is determining whether the main problem is stability, biology, infection—or a combination.
Fracture Malunion
A malunion is a fracture that healed, but healed shortened, angled or rotated in the wrong position.
Correction is considered when the deformity causes pain, weakness, limb-length difference, limited joint motion or abnormal mechanics.
Bone Healing Has to Be “Just Right”
The fracture needs enough stability to allow healing—but the fixation strategy must also create the correct mechanical environment for that fracture pattern. Too much motion can prevent bridging. In some situations, a construct that is too stiff for the intended healing method can also limit the useful stimulation needed for callus formation.
At the same time, the bone needs adequate blood supply, healthy tissue and sufficient biologic activity. Successful healing depends on mechanics and biology working together.
Why fractures fail to heal
There Is Usually More Than One Possible Explanation
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Wrong Mechanical Environment
The construct may be too flexible, poorly balanced or occasionally too rigid for the intended type of healing.
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Poor Alignment or Biology
Large gaps, deformity, damaged blood supply, severe trauma or missing bone can make healing much more difficult.
4
Infection or Patient Factors
Occult infection, nicotine exposure, uncontrolled medical conditions, poor nutrition or inability to follow restrictions can interfere with healing.
Second-opinion evaluation
Before Recommending More Surgery, We Ask Why the First Treatment Failed
A revision operation should address the reason for failure, not simply replace the same hardware.
Imaging
Alignment and Stability
X-rays and sometimes CT imaging help assess healing, fracture gaps, deformity, hardware position and whether the bone is moving.
Biology
Blood Supply and Infection
The evaluation may include laboratory testing, review of wounds and prior cultures, and planning for tissue or bone cultures if revision surgery is performed.
Whole patient
Healing Readiness
Nicotine use, diabetes control, nutrition, medication history and the ability to follow weight-bearing restrictions all affect the revision plan.
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Revision Surgery Requires a Partnership
Nonunion reconstruction can be extensive, and success depends on both the operation and the healing environment afterward. Active nicotine use significantly increases healing and wound risk. Elective reconstruction may need to be postponed until nicotine has stopped and other modifiable risks are appropriately optimized.
Treatment options
Not Every Delayed Fracture Needs Immediate Revision Surgery
Treatment depends on the fracture, time since injury, symptoms, progression on imaging and the identified cause of poor healing.
Selected delayed unions
Observation and Optimization
If the fracture is stable and still progressing, treatment may include protected activity, nutrition and medical optimization, and additional follow-up imaging.
Selected cases
Bone Stimulation
Electrical or ultrasound bone stimulation may be considered for certain delayed unions or nonunions. It is an adjunct—not a substitute for correcting major instability, deformity or infection.
Established failure
Revision Reconstruction
Surgery may require removing failed hardware, correcting alignment, cleaning unhealthy tissue, adding stronger fixation and placing bone graft or other biologic material.
Revision Surgery Can Be Much More Extensive Than the Original Operation
Scar tissue, broken hardware, bone loss, deformity and possible infection can make reconstruction technically demanding. The plan may involve new plates or nails, compression of the nonunion, bone grafting, corrective osteotomy or staged treatment.
Who should seek another opinion?
Consider a Fracture-Healing Second Opinion When Progress Has Stopped
Reasons to Request Evaluation
- Persistent pain months after the fracture
- No meaningful change on serial X-rays
- Motion or clicking at the fracture site
- Broken, bent or loose hardware
- A limb that healed shortened, angled or rotated
- Uncertainty about whether more waiting is reasonable
Bring the Entire Story
Please bring the original injury images, postoperative X-rays, most recent studies, operative reports, implant information, laboratory results and any prior culture reports.
Seeing the sequence of healing—not just one current X-ray—often helps explain when and why progress stopped.
Local revision fracture care
Nonunion and Malunion Second Opinions Serving Atlanta and the East Metro Region
Atlanta Bone and Joint Specialists evaluates fractures that have not healed, healed in the wrong position or failed previous fixation.
Atlanta
Decatur
Snellville
Loganville
Fulton County
DeKalb County
Gwinnett County
Walton County
When scheduling, tell our team that you are requesting a nonunion, malunion or failed-fracture-fixation second opinion. Bring all prior imaging and operative records whenever possible.
Nonunion and malunion FAQ
Frequently Asked Questions
What is the difference between delayed union and nonunion?
A delayed union is healing more slowly than expected but may still be progressing. A nonunion has shown inadequate progression toward solid healing and may require additional treatment.
Why would a fracture stop healing?
Possible causes include excessive motion, an unsuitable fixation environment, poor alignment, a fracture gap, damaged blood supply, bone loss, infection, nicotine exposure or other medical and nutritional factors.
Can fixation be too rigid?
The correct stiffness depends on the fracture and the intended method of healing. Some fractures need absolute stability; others heal through controlled callus formation. A construct that creates the wrong strain environment can contribute to poor healing.
Can a bone stimulator prevent revision surgery?
Sometimes a bone stimulator is useful for a selected delayed union or nonunion. It cannot reliably correct major instability, deformity, broken hardware, a large gap or infection.
Why is nicotine cessation required?
Nicotine reduces blood flow and interferes with bone and wound healing. Because revision nonunion surgery is extensive, the healing risks should be optimized before an elective reconstruction.
What can revision surgery involve?
Revision may include hardware removal, correction of alignment, debridement, cultures, stronger fixation, compression of the nonunion and bone grafting. Some infected cases require staged surgery.
Your Fracture Is Not Healing. The Next Step Is Understanding Why.
Request a focused second opinion from Atlanta Bone and Joint Specialists to review the mechanics, biology, alignment and realistic options for achieving union.
This page provides general educational information and does not replace an examination, complete imaging review, infection workup or individualized medical advice. A second-opinion evaluation does not guarantee that surgery will be recommended or that every patient is an appropriate candidate for revision reconstruction.