Fracture Non-Union & Delayed Bone Healing

Common Symptoms

• Persistent pain or tenderness at a fracture site well beyond the typical healing timeline
• Continued movement or instability at the fracture site
• Imaging (X-ray or CT) showing incomplete bridging of the bone, or a visible gap, months after the injury
• Swelling that doesn't fully resolve as expected during normal healing
• A fracture site that remains painful with weight-bearing or use long after a comparable injury would typically have healed

Why It Happens

Most fractures heal on a predictable timeline as the body forms new bone across the break. Delayed union and non-union happen when that process stalls — due to factors like inadequate blood supply to the fracture site, excessive motion at the fracture during healing, infection, smoking, certain medications, diabetes, or simply the fracture's location and pattern. High-energy shockwaves are thought to stimulate the same mechanobiological healing signals (growth factor release, new blood vessel formation, stem cell recruitment) that a properly healing fracture would generate on its own.

Why It Can Become Persistent

Once healing has genuinely stalled — a true non-union rather than a fracture that's simply healing slowly — it typically will not resolve with more time or rest alone; the biological healing process needs to be actively restarted, which is why non-unions are usually addressed with a specific intervention (revision surgery, bone grafting, or in appropriate cases, shockwave therapy) rather than continued waiting.

Who Commonly Gets It

This affects people who've had fractures at locations with an inherently lower healing rate — including the scaphoid (wrist), fifth metatarsal (foot), tibia (shin), humerus (upper arm), and clavicle (collarbone) — as well as people with risk factors that slow bone healing generally, such as smoking, diabetes, certain medications, or a fracture with significant gapping or instability from the start.

How It Is Usually Diagnosed

Non-union and delayed union are diagnosed by the physician managing your fracture care, based on serial X-rays or CT imaging showing a lack of healing progress over an expected timeframe (commonly around 3 months for delayed union, 6-9 months for non-union, though definitions vary by bone and fracture type), combined with your symptoms and exam findings.

Traditional Treatment Options

• Continued immobilization/bracing: Sometimes extended if healing is progressing slowly but not stalled.
• Bone stimulator devices: Low-intensity ultrasound or electromagnetic bone growth stimulators are a non-invasive option for some delayed unions.
• Revision surgery with bone grafting: Surgically re-fixing the fracture and adding bone graft material is the traditional, well-established treatment for an established non-union.
• Addressing underlying risk factors: Smoking cessation, optimizing nutrition, and reviewing medications that may impair healing.

Why Someone Might Start Looking for Another Option

Revision surgery is effective but is still a surgery — with its own recovery time, risks, and cost — and some patients either aren't good surgical candidates or want to understand non-surgical options before committing to another operation, especially for a fracture that's already been through one surgical procedure.

Where Shockwave Therapy May Fit

High-energy focused extracorporeal shockwave therapy has a genuine, independently published evidence base specifically for delayed union and non-union fractures, including a randomized controlled trial in the Journal of Bone and Joint Surgery comparing shockwave therapy with surgical screw fixation for non-union fifth metatarsal fractures, and additional published research on humeral non-unions and the broader mechanism of shockwave-assisted bone repair. This is a more specialized application than most conditions on this site, and it's only appropriate with close coordination between our practice and the physician managing your fracture.

How Shockwave Treatment Works for This Area

Focused shockwaves are directed precisely at the fracture site under guidance appropriate to the bone involved, aiming to restart the biological signals associated with bone healing. This requires your prior fracture imaging and, in most cases, direct communication with your treating orthopedic surgeon before treatment is considered.

What the Treatment Feels Like

Treatment directly over a fracture site is often more intense than shockwave therapy for soft-tissue conditions, and your provider will discuss energy level, positioning, and what to expect based on the specific bone and fracture involved.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone who has not had the diagnosis of delayed union or non-union confirmed by the physician managing their fracture
• Fractures with significant ongoing instability, large bone gaps, or infection, which typically need surgical management
• Active infection at or near the fracture site
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening
• Pregnancy, in the treatment area, unless specifically cleared by your provider

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.