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    Non Union

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    Haziq Anuar
    This document discusses nonunion bone fractures, including the definition, causes, classification, and treatment options. Nonunion occurs when a fractured bone fails to heal properly. It discusses three main types of nonunion - hypertrophic (excess callus formation but mechanical instability), atrophic (lack of healing capacity), and oligotrophic (no callus). Treatment can be nonoperative using ultrasound, electric stimulation, or bone marrow injection, or operative using bone grafting, plating, intramedullary nailing, or external fixation to improve stability and stimulate healing.

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    Non Union

    Uploaded by

    Haziq Anuar
    146 views25 pages
    This document discusses nonunion bone fractures, including the definition, causes, classification, and treatment options. Nonunion occurs when a fractured bone fails to heal properly. It discusses three main types of nonunion - hypertrophic (excess callus formation but mechanical instability), atrophic (lack of healing capacity), and oligotrophic (no callus). Treatment can be nonoperative using ultrasound, electric stimulation, or bone marrow injection, or operative using bone grafting, plating, intramedullary nailing, or external fixation to improve stability and stimulate healing.

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    This document discusses nonunion bone fractures, including the definition, causes, classification, and treatment options. Nonunion occurs when a fractured bone fails to heal properly. It discusses three main types of nonunion - hypertrophic (excess callus formation but mechanical instability), atrophic (lack of healing capacity), and oligotrophic (no callus). Treatment can be nonoperative using ultrasound, electric stimulation, or bone marrow injection, or operative using bone grafting, plating, intramedullary nailing, or external fixation to improve stability and stimulate healing.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    146 views25 pages

    Non Union

    Uploaded by

    Haziq Anuar
    This document discusses nonunion bone fractures, including the definition, causes, classification, and treatment options. Nonunion occurs when a fractured bone fails to heal properly. It discusses three main types of nonunion - hypertrophic (excess callus formation but mechanical instability), atrophic (lack of healing capacity), and oligotrophic (no callus). Treatment can be nonoperative using ultrasound, electric stimulation, or bone marrow injection, or operative using bone grafting, plating, intramedullary nailing, or external fixation to improve stability and stimulate healing.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 25

    Non Union

    CY/RR/HC/YD/RG

    Definition
    Nonunion failure of fracture bone
    to unite
    Diagnosed can determined clinically /
    radiographically that healing has
    ceased and union is highly
    improbable

    Etiology
    (1) distraction and separation of the
    fragments, sometimes the result of
    interposition of soft tissues between the
    fragments;
    (2) excessive movement at the fracture line
    (3) A severe injury that renders the local
    tissues nonviable or nearly so
    (4) a poor local blood supply
    (5) infection

    Classification
    (1) Hypertrophic
    (2) Atrophic
    (3) Oligotrophic

    Hypertrophic
    Hypervascular
    Possess bioligic capacity to heal but lack
    mechanical stability
    Callus formation present on x-ray
    Elephant foot - abundant callus
    Horse hoof - less abundant callus

    atrophic
    avascular and lack the bioogic
    capacity to heal
    similar to oligotrophic on x-ray

    Oligotrophic
    No callus on x-ray
    Vascularity is present on bone scan

    Hypertrophic non-unions often have florid streams of callus around the


    fracture gap the result of insufficient stability. They are sometimes
    given colourful names, such as: (a) elephants foot.
    Atrophic non-unions
    usually arise from an impaired repair process; they are classified
    according to the x-ray appearance as (b) necrotic, (c) gap and (d)
    atrophic.

    Treatment
    Nonoperative
    Operative

    Nonoperative
    Ultrasound
    Electric stimulator
    Bone marrow injection

    Ultrasound
    Ultrasound fracture stimulation
    devices have shown ability to
    increase callus response in fresh
    fractures (shortens time for visible
    callus on x-ray)
    Use in nonunions remains
    theoretical

    Electric Stimulation
    Piezoelectric nature of bone - stress
    generated electric potentials exist in
    bone and are related to callus formation

    Electromagnetic fields influence


    vascularization of fibrocartilage, cell
    proliferation & matrix production

    Bone Marrow Injection


    Percutaneous bone marrow injected to
    level of fracture

    Surgical Treatment

    Fibular osteotomy
    Bone graft
    Plate osteosynthesis
    Intramedullary nailing
    External fixation

    Fibular Osteotomy
    Often used as adjunctive procedure
    to assist with deformity correction
    and surgical stabilization of tibia

    Bone Grafting
    Osteoinductive - contain proteins or
    chemotactic factors that attract
    vascular ingrowth and healing
    Osteoconductive - contains a
    scaffolding for which new bone
    growth can occur

    Bone Grafting
    Used to stimulate biologic response of
    healing in nonunions (usually atrophic
    nonunions)
    Also used to fill defects in fracture zone
    i.e. up to 6 cm intercalary defects of long
    bones)
    Bosse, MJ e.t.al. JBJS 1989

    Plate Osteosynthesis
    Restores function & stabilizes fracture
    fragments directly
    Compresses fragments in some
    circumstances to augment healing
    Often used with adjunctive bone graft

    Intramedullary Nailing
    Mechanically stabilizes long bone
    nonunions as a load sharing implant
    Corrects malalignment
    Reaming is initially detrimental to
    intramedullary blood supply, but it does
    recover and is believed to stimulate
    biologic healing at fracture

    External Fixation
    Correct malalignment
    Used primarily in management of infected
    nonunions

    THANK YOU

    45-year old lady has nonunion of closed


    fracture lower third shaft of tibia of nine
    months duration. The most likely cause
    of this nonunion is
    A. comminution of the fracture
    B. distraction of the fragments
    C. interposition of soft tissue
    D. absence of muscle origin from it
    E. intact fibula

    How to treat atrophic non union ?


    (disuse atropic,disuse osteoporosis
    and leg length discrepancy 10 cm)
    Explain therapy non union fr. with
    infection?

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