Non Union - Delayed union fractures
Shockwave Therapy for Non-Union Fractures | Sunbury & Melton
Non-union and delayed union fractures occur when a broken bone does not heal within the expected timeframe. Shockwave therapy is a non-invasive treatment that has been investigated as a way to stimulate bone healing in selected cases. Evidence suggests it may support bone regeneration and improve healing rates for some established non-unions, although results vary. Appropriate diagnosis, imaging, fracture stability assessment, and medical guidance are essential before beginning treatment. Health Wise Chiropractic provides personalised musculoskeletal assessments in Sunbury and Melton to help determine suitable care options.
Shockwave therapy may help support the healing process in some delayed union and non-union fractures by stimulating biological activity around the injured bone. Research suggests that extracorporeal shockwave therapy (ESWT) may encourage bone remodelling, improve local blood supply, and activate bone-forming processes in carefully selected patients. However, it is not suitable for every fracture, and outcomes depend on factors such as fracture type, location, stability, blood supply, overall health, and previous treatment.
A delayed union fracture occurs when a broken bone takes longer than expected to heal, while a non-union fracture occurs when the bone has failed to heal within the expected timeframe. These conditions can affect people after traumatic injuries, surgery, stress fractures, or fractures complicated by reduced healing capacity.
At Health Wise Chiropractic, practitioners in Sunbury and Melton provide evidence-informed musculoskeletal care and can help assess whether shockwave therapy may be appropriate as part of a broader rehabilitation plan. A thorough assessment is essential before recommending treatment, and some cases require referral to an orthopaedic specialist.
Non-union and delayed union fractures occur when a broken bone does not heal within the expected timeframe. Shockwave therapy is a non-invasive treatment that has been investigated as a way to stimulate bone healing in selected cases. Evidence suggests it may support bone regeneration and improve healing rates for some established non-unions, although results vary. Appropriate diagnosis, imaging, fracture stability assessment, and medical guidance are essential before beginning treatment. Health Wise Chiropractic provides personalised musculoskeletal assessments in Sunbury and Melton to help determine suitable care options.
What Is This Condition?
A fracture occurs when the normal structure of a bone is disrupted due to excessive force, repetitive stress, or weakened bone tissue. After a fracture, the body begins a complex repair process involving inflammation, new tissue formation, and gradual remodelling of the bone.
Most fractures heal successfully with appropriate management. However, some fractures experience delayed healing or fail to unite properly.
What Is a Delayed Union Fracture?
A delayed union fracture occurs when the bone is healing more slowly than expected but continues to show signs of repair.
Bone healing timelines vary depending on:
The bone involved
The location of the fracture
The severity of the injury
Age and overall health
Blood supply to the area
Mechanical stability of the fracture
Nutrition and lifestyle factors
For example, smaller bones may heal within several weeks, while larger weight-bearing bones may require several months.
A delayed union does not necessarily mean the fracture will fail to heal. Many delayed fractures eventually progress to normal healing with appropriate management.
What Is a Non-Union Fracture?
A non-union fracture occurs when the normal healing process stops and the two broken bone surfaces fail to join together.
A fracture may be classified as a non-union when there is little or no evidence of healing over an extended period, often around six months after injury, although definitions vary depending on the bone and clinical guidelines.
Non-unions may develop when the body is unable to create enough new bone tissue, when the fracture lacks sufficient stability, or when biological factors interfere with repair.
How Does Bone Healing Occur?
Bone healing involves several overlapping stages:
1. Inflammatory Phase
Immediately after injury, the body creates an inflammatory response. Blood vessels damaged during the fracture form a clot around the injury site, creating a foundation for repair.
2. Repair Phase
The body begins producing new connective tissue and immature bone. A structure called a callus forms around the fracture, helping stabilise the area.
3. Remodelling Phase
The new bone gradually strengthens and reshapes according to the stresses placed upon it.
When healing is disrupted, the repair process may slow or stop.
Common Symptoms
Symptoms may include:
Persistent pain at the fracture site
Swelling or tenderness
Reduced strength or function
Difficulty returning to normal activities
Ongoing discomfort with movement or weight-bearing
A feeling that the injured area has not improved as expected
Some people experience minimal symptoms despite delayed healing, which is why imaging and clinical assessment are important.
Acute Versus Chronic Fracture Healing Problems
An acute fracture refers to a recent injury where healing is expected to occur normally.
Delayed union and non-union represent longer-term healing problems. They may require additional investigation, rehabilitation strategies, or specialist management.
Prognosis
Recovery depends on many individual factors, including:
Fracture location
Time since injury
Previous treatments
Bone health
Stability of the fracture
Overall health
Some non-union fractures respond well to interventions designed to stimulate healing, while others may require surgical approaches such as bone grafting or fixation procedures.
A personalised assessment is important to determine the most appropriate pathway.
Who May Benefit From Shockwave Therapy?
Shockwave therapy may be considered for people who have:
A confirmed delayed union fracture
A confirmed non-union fracture
A fracture that has adequate stability
No active infection at the treatment site
Appropriate imaging confirmation
Medical clearance where required
Examples of fractures where shockwave therapy has been investigated include:
Tibial shaft non-unions
Femoral non-unions
Scaphoid non-unions
Long bone fractures
Stress fractures that demonstrate delayed healing
The suitability of treatment depends on individual circumstances.
Who May Not Be Suitable for Shockwave Therapy?
Shockwave therapy may not be appropriate or may require specialist review in situations such as:
An unstable fracture
Acute fractures requiring immediate immobilisation
Suspected infection
Certain vascular conditions
Blood clotting disorders
Use of anticoagulant medications
Pregnancy over the treatment area
Tumours or cancer near the treatment site
Areas with impaired sensation where treatment feedback is limited
A healthcare professional should assess risks and benefits before treatment begins.
What Happens During Your Appointment?
A shockwave therapy appointment at Health Wise Chiropractic begins with a detailed assessment to understand your injury, symptoms, previous treatments, and current limitations.
Initial Health History
Your practitioner will discuss:
How the fracture occurred
When the injury happened
Previous imaging results
Treatments already attempted
Current symptoms and activity limitations
Relevant health factors that may influence healing
Physical Assessment
The assessment may include:
Examination of movement and function
Assessment of surrounding muscles and joints
Evaluation of tenderness and sensitivity
Review of rehabilitation needs
Where appropriate, imaging reports or specialist recommendations may be reviewed.
Treatment Planning
If shockwave therapy appears appropriate, your practitioner will explain:
How the treatment works
Expected sensations
Potential benefits and limitations
Number and frequency of sessions
Any precautions
If shockwave therapy is not considered suitable, referral to another healthcare provider may be recommended.
During Treatment
The practitioner applies the shockwave handpiece to the targeted area.
You may feel:
Pulsing sensations
Pressure
Mild discomfort
Treatment intensity is adjusted according to comfort and clinical requirements.
Aftercare Advice
After treatment, advice may include:
Avoiding excessive loading of the area immediately after treatment
Following rehabilitation exercises
Maintaining appropriate activity levels
Monitoring symptoms
Your recovery plan will be personalised based on your fracture and overall condition.
Home Care & Exercises
Rehabilitation is an important part of recovery from delayed union and non-union fractures. While shockwave therapy may help stimulate biological processes involved in healing, appropriate loading, mobility, strength, and general health management also influence recovery.
Exercise selection depends on the fracture location, healing stage, medical advice, and individual capacity. The following exercises are general examples only and may not be suitable for every fracture. Patients should follow their treating practitioner’s recommendations before starting or progressing exercises.
1. Gentle Range of Motion Exercises
Purpose:
Maintain joint mobility and reduce stiffness around the injured area.
Instructions:
Move the nearby joint slowly through a comfortable range.
Avoid forcing painful movements.
Perform controlled movements rather than fast or repetitive motions.
Examples may include:
Ankle circles after lower leg injuries
Wrist movements after forearm injuries
Gentle knee bends after lower limb fractures
Repetitions:
10–15 repetitions
Frequency:
1–3 times daily
Progression:
Gradually increase movement range as comfort improves and healing progresses.
2. Isometric Muscle Contractions
Purpose:
Maintain muscle activation without placing excessive movement stress through the healing area.
Instructions:
Contract the surrounding muscle without moving the joint.
Hold the contraction gently.
Relax fully between repetitions.
Examples:
Thigh muscle tightening after lower limb injuries
Forearm muscle contractions after wrist injuries
Repetitions:
Hold for 5–10 seconds
Repeat 10 times
Frequency:
Daily or as advised
Progression:
Increase contraction strength gradually as tolerated.
3. Supported Weight-Bearing Exercises
Purpose:
Gradually reintroduce appropriate loading to encourage functional recovery.
Instructions:
Only perform weight-bearing exercises if cleared by your healthcare provider.
Examples may include:
Standing with support
Gentle weight shifts
Partial loading through the affected limb
Repetitions:
10 controlled repetitions
Frequency:
Daily when appropriate
Progression:
Increase weight-bearing time and resistance under professional guidance.
4. Resistance Band Strengthening
Purpose:
Restore strength and support surrounding joints and tissues.
Instructions:
Use a light resistance band.
Perform slow controlled movements.
Avoid exercises that cause sharp pain around the fracture site.
Examples:
Ankle resistance movements
Wrist strengthening
Shoulder or hip strengthening depending on injury location
Repetitions:
2 sets of 10 repetitions
Frequency:
2–3 times per week
Progression:
Gradually increase resistance as strength improves.
5. Balance and Functional Training
Purpose:
Improve confidence, coordination, and return to everyday activities.
Instructions:
Examples include:
Standing on one leg with support
Controlled step-ups
Functional movement drills
Repetitions:
5–10 repetitions
Frequency:
Several times per week
Progression:
Increase challenge by reducing support, increasing duration, or adding resistance.
Prevention Tips
While not all fractures can be prevented, maintaining strong bones, healthy movement patterns, and good lifestyle habits may reduce fracture risk and support recovery.
Maintain Bone Health
Helpful strategies include:
Eating a balanced diet with adequate calcium and protein
Maintaining healthy vitamin D levels
Participating in regular weight-bearing exercise
Avoiding smoking
Limiting excessive alcohol intake
Improve Workplace and Exercise Habits
When returning to work or sport:
Increase activity gradually
Avoid sudden increases in training load
Use appropriate protective equipment where relevant
Allow adequate recovery between sessions
Safe Lifting Techniques
To reduce unnecessary strain:
Bend through the hips and knees
Keep loads close to your body
Avoid twisting while lifting
Ask for assistance with heavy objects
Sleep and Recovery
Quality sleep supports general recovery.
Helpful habits include:
Maintaining consistent sleep times
Creating a comfortable sleep environment
Managing stress before bedtime
Manage Stress and Recovery Load
Chronic stress may negatively affect sleep, recovery behaviours, and overall wellbeing.
Strategies may include:
Relaxation exercises
Breathing techniques
Gentle movement
Maintaining social connection
Follow Rehabilitation Advice
Returning to activity too quickly may overload healing tissues.
A structured rehabilitation plan helps balance:
Protecting the healing fracture
Maintaining strength
Restoring movement
Returning to normal activities safely
Fractures represent a significant health burden in Australia, particularly as the population ages and conditions affecting bone strength become more common.
According to the Australian Institute of Health and Welfare (AIHW), fractures contribute substantially to hospital admissions, healthcare costs, disability, and reduced quality of life.
Key Australian fracture-related statistics include:
Osteoporosis affects hundreds of thousands of Australians and contributes to increased fracture risk, particularly hip, vertebral, and wrist fractures.
More than 183,000 hospitalisations in Australia each year are associated with injury-related fractures and falls, according to national health reporting data.
Fragility fractures are a major concern among older Australians because they can lead to reduced independence and long-term health impacts.
Fracture healing complications such as delayed union and non-union are less common than successful fracture healing but can create significant disability, ongoing pain, and healthcare needs.
Non-union rates vary widely depending on fracture location and injury severity. Long bone fractures, particularly those involving areas with reduced blood supply or significant trauma, generally have higher risks of delayed healing.
Because delayed union and non-union fractures are relatively uncommon compared with uncomplicated fractures, individual assessment and specialist diagnosis are essential.
Evidence & Clinical Guidelines
Research into shockwave therapy for delayed union and non-union fractures has shown promising results, particularly for selected cases where fracture stability is adequate and biological stimulation is required. However, evidence quality varies, and shockwave therapy should be considered alongside established orthopaedic management rather than as a replacement.
A systematic review published in Injury evaluated extracorporeal shockwave therapy for fracture non-unions and reported encouraging healing outcomes across multiple fracture types, although researchers noted differences in treatment protocols and study quality.
Source:
Alkhawashki HM et al. Extracorporeal shock wave therapy for fracture non-unions: systematic review. Injury.
https://pubmed.ncbi.nlm.nih.gov/
Research has reported union rates commonly ranging from approximately 60–90% in selected non-union cases treated with shockwave therapy, although outcomes vary depending on fracture type, patient factors, and study design.
A review published in Clinical Orthopaedics and Related Research investigated extracorporeal shockwave therapy for delayed and non-union fractures and found evidence supporting its potential role in stimulating bone healing.
Source:
https://pubmed.ncbi.nlm.nih.gov/
Clinical considerations from current evidence include:
Shockwave therapy appears most appropriate for selected delayed union and non-union fractures.
Stable fracture alignment is important for successful healing.
Imaging confirmation and appropriate diagnosis are essential.
Some patients require surgical management rather than conservative treatment.
More high-quality randomised controlled trials are needed to establish optimal treatment protocols.
Australian guidelines emphasise the importance of fracture prevention, osteoporosis management, appropriate imaging, and coordinated care between medical and rehabilitation professionals.
For complex fracture healing concerns, assessment by a GP and orthopaedic specialist remains an important part of care planning.
Frequently Asked Questions
1. Can shockwave therapy help a non-union fracture?
Shockwave therapy may help stimulate bone healing in some non-union fractures by encouraging biological activity, improving local circulation, and supporting bone remodelling. However, it is not suitable for every fracture and does not guarantee healing. A thorough assessment, including fracture history and imaging where available, is required to determine whether shockwave therapy is appropriate.
2. What is the difference between a delayed union and a non-union fracture?
A delayed union fracture is one that is healing more slowly than expected but continues to show signs of repair. A non-union fracture occurs when the normal healing process has slowed significantly or stopped, and the fracture does not successfully join together within the expected timeframe.
The difference is usually determined through clinical assessment, imaging, and monitoring over time.
3. How does shockwave therapy work for fracture healing?
Shockwave therapy delivers controlled acoustic waves into the targeted area. These mechanical waves may stimulate biological processes involved in bone repair, including increased activity of bone-forming cells, improved blood vessel formation, and release of healing-related growth factors.
The exact mechanisms are still being researched, and results vary between individuals.
4. Is shockwave therapy a replacement for fracture surgery?
No. Shockwave therapy is not a replacement for surgery when surgery is required.
Some non-union fractures need procedures such as fixation, bone grafting, or correction of mechanical problems preventing healing. Shockwave therapy may be considered as part of a broader management plan in appropriately selected cases.
5. Is shockwave therapy painful?
Shockwave therapy can create a tapping, pressure, or uncomfortable sensation during treatment. The intensity can usually be adjusted according to patient comfort and clinical requirements.
Mild soreness after treatment may occur, but experiences vary between individuals.
6. How many shockwave therapy sessions are needed for a non-union fracture?
The number of sessions depends on the fracture type, location, healing stage, treatment goals, and individual response.
Unlike some soft tissue conditions where standard treatment schedules are commonly used, fracture healing protocols vary considerably. Your practitioner will discuss a suitable treatment approach based on your assessment.
7. Who should not have shockwave therapy for a fracture?
Shockwave therapy may not be suitable for everyone.
It may require additional medical review or may be unsuitable for people with:
Unstable fractures
Active infection
Certain blood clotting conditions
Some vascular disorders
Tumours near the treatment area
Areas with reduced sensation
Fractures requiring urgent surgical management
A healthcare professional can help determine whether treatment is appropriate.
8. Can shockwave therapy help old fractures that have not healed?
Shockwave therapy has been studied in some established non-union fractures, including fractures that have failed to heal over an extended period.
However, the likelihood of success depends on factors such as:
The location of the fracture
Bone stability
Blood supply
Previous treatments
Overall health
A specialist assessment is recommended before starting treatment for long-standing non-unions.
9. How long does it take for a non-union fracture to heal after shockwave therapy?
Healing timelines vary significantly.
Some patients may show signs of improvement over several months, while others may require additional interventions or longer recovery periods. Bone healing should be monitored through appropriate clinical assessment and imaging rather than symptoms alone.
10. Can Health Wise Chiropractic provide shockwave therapy assessments for fracture healing?
Health Wise Chiropractic provides evidence-informed musculoskeletal assessments and shockwave therapy services at clinics in Sunbury and Melton.
For delayed union or non-union fractures, an assessment helps determine whether shockwave therapy may be appropriate or whether referral to a GP, radiologist, or orthopaedic specialist is recommended.
Why Choose Health Wise Chiropractic?
Managing a delayed union or non-union fracture often requires an individualised approach that considers the person as a whole rather than focusing only on the injury site.
Health Wise Chiropractic provides evidence-informed musculoskeletal care for patients in Sunbury and Melton, combining clinical assessment, rehabilitation principles, and appropriate treatment options.
Patients benefit from:
Experienced practitioners with a focus on musculoskeletal health
Personalised assessment and treatment planning
Evidence-informed approaches based on current research
Rehabilitation guidance to support movement and function
Clear explanations about treatment options and expectations
Collaboration and referral pathways when medical or specialist care is required
Shockwave therapy is only recommended when clinically appropriate. Every patient’s recovery journey is different, and treatment decisions are based on individual assessment, symptoms, goals, and available evidence.
Health Wise Chiropractic offers online bookings for convenient access to chiropractic and musculoskeletal services across Sunbury and Melton.
CTA Text
If you are dealing with a delayed union or non-union fracture and want to understand your available treatment options, Health Wise Chiropractic can help provide a personalised assessment.
Our experienced practitioners in Sunbury and Melton can discuss your symptoms, recovery goals, previous treatment history, and whether shockwave therapy may be appropriate as part of your overall care plan.
Because every fracture and every person is different, treatment recommendations are based on individual assessment and current evidence. Where specialist input is required, appropriate referral pathways can be discussed.
Book an appointment online with Health Wise Chiropractic today to discuss your recovery and explore suitable options for supporting your musculoskeletal health.
Recovery Timeline
Recovery from delayed union and non-union fractures varies significantly between individuals. The timeline depends on the type of fracture, location, severity, biological healing capacity, treatment approach, and overall health.
Mild or Earlier Healing Delays
People with mild delays may notice gradual improvements over weeks to months when contributing factors are addressed.
Recovery may involve:
Reduced discomfort
Improved movement
Increased confidence using the affected area
However, bone healing should be monitored clinically rather than judged by symptoms alone.
Moderate Delayed Healing Cases
Moderate cases may require longer-term management involving:
Medical review
Imaging monitoring
Rehabilitation
Activity modification
Additional treatment options such as shockwave therapy where appropriate
Improvement may occur over several months.
Persistent Non-Union Fractures
Established non-union fractures can require more complex management.
Recovery may involve:
Specialist assessment
Further imaging
Surgical or non-surgical interventions
Longer rehabilitation periods
Some fractures may take many months to improve, and some require multiple treatment approaches.
Factors That Influence Recovery Time
Recovery may be affected by:
Age
Bone quality
Smoking status
Nutrition
Diabetes or other health conditions
Fracture location
Stability of the fracture
Blood supply
Compliance with rehabilitation recommendations
Shockwave therapy may be one component of a broader recovery plan, but it does not guarantee healing.
A personalised assessment is essential to determine the most appropriate pathway.
Non-union and delayed union fractures occur when a broken bone does not heal within the expected timeframe. Shockwave therapy is a non-invasive treatment that has been investigated as a way to stimulate bone healing in selected cases. Evidence suggests it may support bone regeneration and improve healing rates for some established non-unions, although results vary. Appropriate diagnosis, imaging, fracture stability assessment, and medical guidance are essential before beginning treatment. Health Wise Chiropractic provides personalised musculoskeletal assessments in Sunbury and Melton to help determine suitable care options.
Non-union and delayed union fractures occur when a broken bone does not heal within the expected timeframe. Shockwave therapy is a non-invasive treatment that has been investigated as a way to stimulate bone healing in selected cases. Evidence suggests it may support bone regeneration and improve healing rates for some established non-unions, although results vary. Appropriate diagnosis, imaging, fracture stability assessment, and medical guidance are essential before beginning treatment. Health Wise Chiropractic provides personalised musculoskeletal assessments in Sunbury and Melton to help determine suitable care options.