3. Nonunion
When a minimum of 9 months has elapsed since the
injury
&
The fracture shows no radiologically visible progressive
signs of healing continuously for 3 months
12. Causes of nonunion
Compound fractures
Infection
Segmental fractures
Distraction of fracture fragments
Soft tissue interposition
Ill devised open reduction
Insecure and inadequate fixation
13. Clinical features
History
1. Trauma resulting in fractures
2. Open fractures
3. Improper / delay / inadequate treatment
Symptoms
1. Minimal / no pain
2. Loss of function
15. Investigations
X-ray AP and Lateral view
1. Gap between fracture fragments
2. Fragments are rounded and sclerotic
3. Amount of callus formed could be less or more
4. Decreased density of bone is due to osteoporosis
16.
17.
18.
19.
20.
21.
22.
23.
24.
25. Management
Surgery
1. Open reduction
2. Rigid internal fixation
3. Bone grafting
Electrical stimulation
Ilizarov’s technique
26. Bone Graft
Promotes Osteogenesis ,provide stability
Types
1. Cancellous Bone Graft
2. Cortical Bone Graft
3. Phemister Bone Graft
28. Cortical Bone Graft
Fixation + Osteogenesis
Stabilizing property
For nonunion of shafts of any long bones
Single only when placed on one surface
Dual only when it is placed on both sides
Sliding graft piece is sided from above to the fracture
29.
30.
31. Phemister bone graft
Graft is placed subperiosteally
Blood supply is not disturbed
Simple
Placed posteriorly
Useful in tibia
32. Electrical stimulation in Nonunion
20 mA
Fibrous tissue fibrocartilage endochondral
ossification
Types
1. Noninvasive
2. Semi invasive
3. Invasive
Pulsed Electromagnetic field after excision of fibrous
tissue followed by grafting
Immobilization is done to decrease stress
Slow not always successful
33. Ilizarov’s technique
Best for infected nonunions
Corrects deformity + boneloss
In hypertrophic gradual compression
Avascular corticotomy , Bone transport and
compression
Editor's Notes
X ray hip
# neck of femur
# and dislocation
Multple pins
Blade plate fixation
Dynamic hip screw
nonunion
Case Example: - 45 year old female w/ osteomalacia due to Sheenan's syndrome sustained a femoral neck fracture which was treated w/ a compression hip screw; - once the patient progressed w/ weight bearing, the hardware cut out superiorly and the fracture went on to non union;
