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Bone grafts are used when a broken bone fails to heal. This can also be from not healing after lengthening. When this happens, it is called a ‘non-union’ or even a ‘delayed union’ when the bone healing is taking longer than usual to heal, leaving a possible gap with no new bone in this gap. This does not happen often.
There are many reasons why the bone has not healed, and your child’s surgeon has most likely tried non-surgical ways to help the bone heal if possible. Some reason why it does not heal by itself include:
Bones need enough quality nutrition to heal. Eating a healthy, balanced diet is very important and should include calcium, protein, vitamins D and other vitamins.
Blood supply is needed for healing bone as it delivers oxygen, healing cells, and your body’s own growth factors. These are chemicals that are needed to grow new bone.
Different parts of the body have better supplies of blood than others. Trauma and surgery can move the muscles over the bone, and damage the blood supply.
Other risk factors include:
All these risk factors can contribute to a ‘non-union’ or delayed union.
Your child may have already tried a non-surgical approach before requiring a bone graft. If that did not help, they will need a bone graft and other surgical interventions, but this will be discussed with you.
A bone graft is a surgical procedure where the surgeon takes pieces of bone and transplants them elsewhere. For this operation, the surgeon will take some bone from part of the top of the hip bone, called the ‘iliac crest’.
The bone graft acts as a type of scaffolding for new bone to grow and help with healing. It allows blood vessels to grow into the graft to supply nutrients, and then encourage the new bone to grow.
Like most surgical procedures there will be some pain, but we will give your child pain relief to help with this. It is unlikely the pain will be long term.
With any surgery there are risks and complications, but this will be discussed with you before you sign a consent form.
After the bone graft, the surgeon will apply a dressing over the wound sites. If your child had internal fixation, they may need a cast or splint in place to protect the bone.
It is important to help with healing in any way you can, and reduce risk factors. Make sure your child can eat a healthy and balanced diet to give the bone graft the best chance of healing. Follow to any other advice of your surgeon.
Your child will need to have their wounds checked to make sure they are healing well and there are no signs of infection. You should get instructions on what to do when your child is discharged from hospital. If you are worried, you can contact your GP or contact the Ward for advice.
The surgeon will see you to monitor the bone formation until they are happy with its progress. They will then decide to remove the external fixator or cast when they are happy that the bone is strong enough. This can be different for every individual as everyone’s healing is different.
You may be wondering why you have been advised to take vitamin D as a supplement, either before or after the surgery. Vitamin D is very important in bone and dental health and its role in calcium absorption in the body. It also plays an important role in several diseases and also at fighting off infections.
It is sometimes referred to as the ‘sunshine’ vitamin, this is because it is in fact a type of hormone produced in the skin in response to sunlight exposure. It then travels to the liver and kidneys to become activated. It is very difficult in the UK to get enough sunshine for this to happen, so we need to take a supplement of vitamin D.
Visit the Association of UK Dietetics for more information about vitamin D.
If you have any questions or concerns, please contact the paediatric limb reconstruction service (PLRS) on 0114 271 7575, or the Ward 2 and Burns unit on 0114 271 7394.
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.
Resource number: PLR12
Resource Type: Article
Western Bank
Sheffield
S10 2TH
United Kingdom
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