5. ● Contact
○ was there sufficient contact between the fragments
● Alignment
○ Was the fracture adequately aligned, to reduce shear?
● Stability
○ Was the fracture held with sufficient stability?
● Stimulating
○ Was the fracture sufficiently ‘stimulated’? (e.g. by encouraging
weightbearing).
Patient-related reasons
● Poor soft tissue (from either the injury or surgery)
● Drug abuse
● Antiinflammatory or immunosuppressant medication
● Non-compliance
Causes
6. Hypertrophic non-union
● Bone ends enlarged.
● Osteogenesis still active but
not capable of bridging the gap
Atrophic non-union
● bone ends are tapered or rounded
with no suggestion of new bone
formation.
● osteogenesis seems to have ceased
Types of non-union
7. Management
Conservative Operative
● If asymptomatic, no treatment
is needed or at most, a
removable splint is needed
● If symptomatic and
hypertrophic, functional bracing
may be sufficient but splintage is
often prolonged
● If symptomatic and atrophic,
pulsed electromagnetic fields
(PEMF) and low intensity pulsed
ultrasound (LIPU) can also be
used to stimulate union
● If hypertrophic, very rigid
fixation may be sufficient to aid
union
● If atrophic, fibrous tissue in the
fracture gap, sclerotic bone ends
is excised and bone grafts are
packed around the fracture
8. Malunion
Occurs when the fragments join in an
unsatisfactory position (unacceptable
angulation, rotation or shortening)
9. 1. Failure to reduce a fracture
adequately
2. Ineffective immobilization
3. Gradual collapse of
comminuted or osteoporotic
bone
Causes
● Swelling
● Pain
● Tenderness
● Difficulty bearing weight
● Obvious deformity
● Rotational deformity
Clinical Features
10. ADULTS
● Fractures should be reduced as near
to the anatomical position as
possible.
● Angulation of more than 10-15
degrees in a long bone or noticeable
rotational deformity may need
correction by re-manipulation, or by
osteotomy and fixation
Management
CHILDREN
● Angular deformity near the bone ends
will usually remodel with time
● Rotational deformity will not
LOWER LIMB SHORTENING
● Shortening <2cm - compensated by
shoe raise
● Shortening >2cm - limb length
equalizing procedure may be indicated
12. A vascular necrosis ?
Avascular necrosis is a disease that results from
the temporary or permanent loss of blood
supply to the bone. When blood supply is cut off,
the bone tissue dies and the bone collapses.
13. 1st
2nd
3rd
Pelvic , femoral head
knee, talus, and humeral
other bones of the body, such as the carpus
and jaw
Common
Sites
14. Causes of Avascular necrosis
Mnemonic : AVASCULAR
~ Aspirin and other NSAID
~ Vasculitis
~ Alcoholism
~ Sepsis and steroids
~ Cushing ‘s / conception
~ Under water diving
~ Liver diseases
~ Abnormal bleeding
~ Radiotherapy
15.
16.
17. Clinical finding of AVN
Neurological deficicit Joint deformity and
swelling
Initially will be
asymptomatic and
unrevealing
Tenderness around
the affected joint
Restricted and
painful of active and
passive movements
04. 05.
01. 02. 03.
29. Management &
treatment
The gold of the treatment is to reduce the pain and ensure the function of the
affected join and reduce the progression of bone damage
30.
31.
32. CREDITS: This presentation template was created by Slidesgo,
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