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Chronic, Unhealed Fractures (Non-Union)
What is a nonunion?
Most fractures go on to heal without difficulty. However, fractures that demonstrate motion of the bony ends and incomplete healing more than 6 months after injury are called nonunions.
What are the causes of a fracture nonunion?
Of the estimated 6 million fractures in the United States each year approximately 300,000 will develop slow (delayed union) or incomplete healing (nonunion). The reasons for failed fracture healing are often multifactorial and complex. Contributing factors may include:
- Complicated, multisegemental factures (severe comminution)
- Open fractures
- Fractures associated with tumors (pathologic fractures)
- Infection
- Insufficient fracture immobilization (fixation)
- Inadequate blood supply
- Poor nutrition
- Chronic disease states (diabetes, renal failure, metabolic bone disease)
Can fracture nonunions be successfully treated?
Careful analysis to determine the cause or causes of the initial impaired healing is critical to success. After identifying the reasons for the bony nonunion a customized treatment plan can be developed to optimize the fracture environment and opportunity for fracture healing.
Surgical therapies may include provision of more secure fixation with intermedulary rods or compression plating. Intervening soft tissues are removed to allow maximal bony contact and bone grafts taken from the pelvis are often utilized to provide a scaffold for new bone formation. Alternately, old hardware may be removed, infected bone excised and an external frame utilized to both stabilize and transport bone to stimulate fracture healing. Microvascular techniques including vasculaized bone grafts and periosteal free flaps may be utilized for highly complex cases.
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Electrical Bone Stimulator
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Adjunctive techniques are also employed in an effort to enhance fracture healing. These include injection of osteogenic materials and utilization of physical fields such as ultrasound and electrical stimulation.
Careful analysis and treatment by a multidisciplinary team can often produce successful fracture healing allowing patients to resume independent ambulation and a normal lifestyle.
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