Nonunion

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Nonunion is a permanent failure of healing after a fracture unless an intervention (such as surgery) is performed. Fractures with nonunion generally form a structural similarity with fibrous joints, and are therefore often called "false joints" or pseudoarthrosis (Greek "pseudo-" rods mean false and "arthrosis" means joints). Diagnosis is generally made when there is no cure between two sets of X-rays. This is generally after 6-8 months.

Nonunion is a serious complication of fractures and can occur when fractures move too much, have a poor or infected blood supply. Patients who smoked had a higher incidence of nonunion. The normal bone healing process is disrupted or stopped.

Because the bone healing process varies considerably, a nonunion can be cured without intervention in some cases. In general, if nonunion is still proven at 6 months post injury, it will still not recover without special treatment, usually orthopedic surgery. The continuing non-union is called a pending union.

Video Nonunion

Signs and symptoms

The history of fractures is usually obvious. The patient complains of persistent pain at the site of the fracture and may also notice abnormal movements or clicking on the fracture level. An x-ray plate of fractured bone shows a persistent radiolucent line on the fracture. Callus formation can be seen but the callus does not bridge the fracture. If there is any doubt about the x-ray interpretation, x-ray stress, tomogram or CT scan can be used for confirmation.

Maps Nonunion

Cause

The reason for not associating is

• avascular necrosis (blood supply disturbed by fracture)
• both ends are not flanked (ie, they are not adjacent)
Infection
• (especially osteomyelitis)
• the fracture is not fixed (that is, the two ends are still moving)
• the imposition of soft tissue (there is a muscle or ligament covering the broken end and preventing it from touching each other)

Risk factors

1. Related to the person:
   1. Ages: Usual in old age
   2. Nutritional status: bad
   3. Habit: Nicotine and alcohol consumption
   4. Metabolic disorders: Hyperparathyroidism
   5. can be found on those who have NF1
2. Causes related to fractures:
   1. Associated with fracture site
   2. Soft network interposition
   3. Bone loss in fractures
   4. Infection
   5. Loss of blood supply
   6. Muscle damage around
3. Related to treatment
   1. Inadequate reduction
   2. Immobilization is not enough
   3. The fixation device is not implemented correctly.

Hypertrophic non-union

Callus is formed, but bone fractures have not joined. This can be due to inadequate fracture fixation, and is treated with rigid immobilization.

Non-union atrophy

No callus is formed. This is often due to bone healing disorders, eg due to vascular causes (eg disruption of blood supply to bone) or metabolic causes (eg diabetes or smoking). Failure of early unification, for example when bone fragments separated by soft tissue can also lead to non-unified atrophy. Non-union atrophy can be treated by fixing fixation, removing the end layer of bone to provide a standard tip for healing, and the use of bone graft.

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Diagnosis

Diagnosis of nonunion is generally done when there is no progress between medical imaging opportunities such as X-rays. This generally occurs after 6-8 months.

Nonunion Type

Judet and Judet, Muller, Weber and Cech, and others classify nonunions into two types according to the survival of the fragment tip: Nonunions hypervascular and avascular nonunions.

Hypervascular nonunions are divided as:

1. "Elephant foot" nonunions: This is hypertrophic, rich in callus and is a result of inadequate immobilisation, insecure fixation or premature weight bearing.
2. "Horses" nonunions: Slightly hypertrophic, poor in callus and due to unstable fixation.
3. Oligotrophic Nonunions: They are not hypertrophic but vascular, no callus is visible and due to fracture or highly displaced fixation without accurate fragmentation of the fragments.

The avascular armament is divided into:

1. Powerless words of torque have intermediate fragments with a reduced or non-existent blood supply. This fragment has healed to one main fragment but not to another.
2. Comminutal commodities have one or more fractions between necrotics.
3. Defects of nonunions have a gap in the diaphyses of the bones due to loss of fragments.
4. Nonunions of atrophy are usually the end result when the intermediate fragment is lost and scar tissue with no osteogenic potential is left in place.

Paley classifies tibial nonunions based on clinical characteristics and roentgenography as Type A (Bone loss less than 1 cm) and Type B (Bone loss greater than 1 cm). Type A is a subclass as Type A: 1 type Lax; Lax nonunion has limited mobility and usually some disorders remain, Type A: 2: 1 rigid nonunion without deformity and Type A: 2: 2 rigid nonunion with deformity. Type B subclassification as Type B: 1 bony defect without shortening, Type B: 2 shortening without gap and Type B: 3 there are gaps and shorts.

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Treatment

Surgery

Surgical treatment options include:

• Removes all scarring from the fracture fragments
• Immobilization of fracture with internal or external fixation. Metal plates, pins, screws, and rods, screwed or pushed to bone, are used to stabilize broken bone fragments.
• Bone transplantation. The donor bone or autologous bone (taken from the same person undergoing surgery) is used as a stimulus for bone healing. The presence of the bone is thought to cause stem cells in the circulation and marrow to form cartilage, which then turns into bone, not the fibrous scar that forms to heal all other body tissues. Bone is the only tissue that can heal without fibrous scars. Autologous bone graft is a "gold standard" treatment of bone union obtained from iliac crest.

In simple cases, healing can prove within 3 months. Gavriil Ilizarov revolutionized the treatment of unfounded nonunions showing that the affected area of ​​the bone could be removed, the new tip "docked" and the remaining bone extended using an external fixator device. The healing time after such treatment is longer than normal bone healing. There is usually a sign of unity within 3 months, but treatment may continue for months afterwards.

Bone Stimulation

Bone stimulation is possible with electromagnetic or ultrasound waves. Ultrasound stimulation has tentative evidence supporting better healing in long bones that have not healed after three months. Evidence; However from Cochrane's review, it does not show that ultrasound lowers the nonunion level. However, other reviews suggest it as an alternative to surgery.

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Prognosis

By definition, nonunion will not heal if left alone. Therefore the patient's symptoms will not improve and the function of the limb will remain undisturbed. It would be painful to bear the load on it and it could change shape or unstable. The prognosis of nonunion if treated depends on many factors including the age and general health of the patient, the time since the original injury, the number of previous surgery, the smoking history, the patient's ability to cooperate with the treatment. In the region 80% of cured nonunions after the first surgery. The success rate with subsequent operations is less.

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See also

• Osteogenesis disorder

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References

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External links

directory

• AAOS
• Non_union of Orthopedics System Kesehatan Duke University

Source of the article : Wikipedia