This document provides an overview of nonunion fractures, including definitions, classifications, etiology, evaluation, and treatment principles. It defines nonunion as a fracture that has not healed after 9 months and has not shown progression for 3 months. Nonunions are classified as hypervascular (hypertrophic, oligotrophic) or avascular (atrophic, pseudarthrosis). Treatment may involve debridement, plating, intramedullary nailing, bone grafting, BMPs, or electrical stimulation depending on the type and location of the nonunion. The goals are to achieve stability, stimulate healing, correct any deformity, and allow early mobilization.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Non union of fractures dr mohamed ashraf,HOD orthopaedics,govt TD medical col...drashraf369
presentation about pathophysiology and pathmechanics of delayed and non union of fractures.it shows how to manage different types of bone non union. presentation is by Dr Mohamed ashraf professor and head of orthopaedics,govt TD medical college, alleppey,kerala,india
Appraoch to patient with polytrauma and Damage control orthopedicsKaushal Kafle
A brief approach to patient with polytrauma, physiological response of body with trauma, the trimodal mortality, golden hour, lethal triad of trauma, two hit hypothesis, inflammatory mediators, prehospital care, primary survey, secondary survey, ABCDE approach, Adjucts are included. Besides thc concept of Damage control orthopedics, trend in fracture management , evolution , principle, indication , surgical stratergies, advantage, limitation, definitive fixation and EAC and ETC are included in breif.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Non union of fractures dr mohamed ashraf,HOD orthopaedics,govt TD medical col...drashraf369
presentation about pathophysiology and pathmechanics of delayed and non union of fractures.it shows how to manage different types of bone non union. presentation is by Dr Mohamed ashraf professor and head of orthopaedics,govt TD medical college, alleppey,kerala,india
Appraoch to patient with polytrauma and Damage control orthopedicsKaushal Kafle
A brief approach to patient with polytrauma, physiological response of body with trauma, the trimodal mortality, golden hour, lethal triad of trauma, two hit hypothesis, inflammatory mediators, prehospital care, primary survey, secondary survey, ABCDE approach, Adjucts are included. Besides thc concept of Damage control orthopedics, trend in fracture management , evolution , principle, indication , surgical stratergies, advantage, limitation, definitive fixation and EAC and ETC are included in breif.
Presentation on Spinal Metastases Scorng system and Decision making
By
Dr.SHASHIDHAR B K
Bangalore Spine Specialist Clinic
www.spinesurgeonbangalore.com
drshashidharbk@gmail.com
Spine and extremity injuries are common among people of all ages and can have a significant impact on mobility and quality of life. This PowerPoint presentation provides a comprehensive overview of spine and extremity injuries, including the causes, symptoms, and treatment options.
Through powerful images and personal stories, we showcase the impact of spine and extremity injuries on individuals, families, and communities. We highlight the challenges of accessing healthcare and rehabilitation services, particularly in low-resource settings, and the importance of early intervention and treatment.
The presentation provides detailed information about the various types of spine and extremity injuries, including fractures, dislocations, and soft tissue injuries. We also discuss the diagnostic procedures, including imaging tests and physical exams, and the treatment options, such as surgery, physical therapy, and pain management.
In addition, we explore the efforts being made to prevent and manage spine and extremity injuries. We highlight the importance of safety precautions, such as proper equipment use and ergonomic work practices, and the role of rehabilitation services in promoting recovery and restoring function.
Through this PowerPoint presentation, we aim to raise awareness about spine and extremity injuries and the importance of early diagnosis and treatment. We showcase the latest research and innovations in injury prevention and treatment, and the importance of collaboration and partnership to address the disease.
We urge the audience to take action in the fight against spine and extremity injuries, whether it be through spreading awareness, supporting organizations working on the ground, or advocating for policy change. Let us come together to create a world where everyone has access to the care and support they need to recover from spine and extremity injuries and live healthy, fulfilling lives.
perioperative preparations in obstetrics and Gynecology.pptxEkramNasher
This PowerPoint describe all preparations that doctors follow during preparation obstetrical and Gynecological cases for operations and the important instructions which should be taken
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Nonunion ppt
1. NONUNION
GENERAL PRINCIPLES & TREATMENT METHODS
:- DR KULDEEP DHANKHAR
3rd yr ORTHO RESIDENT
GUIDE:- DR MAHESH BHATI
DEPT. OF ORTHOPAEDICS
DR S.N.MEDICAL COLLEGE,
JODHPUR
3. DEFINITIONS:-
Nonunion: (somewhat arbitrary)
A fracture that has not and is not going to
heal
Delayed union:
A fracture that requires more time than
usual to heal
Shows progression over time
4. DEFINITIONS:-
Nonunion: A fracture that is a minimum of
9 months post occurrence and is not
healed and has not shown radiographic
progression for 3 months (FDA 1986)
Not pragmatic
Prolonged morbidity
Narcotic abuse
Work-related and/or emotional impairment
5. Definitions (pragmatic):-
Nonunion: A fracture that has no potential
to heal without further intervention
-:9 months elapsed time
with no healing progress for
3 months.
10. 2.Oligotrophic:-
Some/minimal callus on x-ray
Not an aggressive healing response, but not
completely void of biologic activity
Vascularity is present on bone scan
Oligotrophic
14. Etiology of Nonunion:-
Host factors
Fracture/Injury factors
Initial treatment of injury factors
Complicating factor = Infection
15. Etiology of Nonunion – (Host
Factors):-
Smoking
Diabetes/Endocrinopathy
Thyroid/ parathyroid disorders, hypogonadism
[testosterone deficiency], Vit D deficiency, others
Malnutrition
Medications
Steroids, Chemotherapy, Bispohosphonates
Bone quality, vascular status
Balance, compliance with weight bearing
restrictions
Psychiatric conditions, dementia
16. • Smoking:-
Decreases peripheral oxygen
tension
Dampens peripheral blood flow
Well documented difficulties in
wound healing in patients who
smoke
• Retrospective studies show
time to union
• Higher infection and nonunion
rates
17. • Diabetes
(Neuropathic Fractures):-
Best studied in ankle and pilon fractures:
Complicated diabetics – those with end organ
disease – neuropathy, PVD, renal dysfunction
Increased rates of infection and soft tissue
complications
Increased rates of nonunion, time to union
significantly longer
Prolonged NWB required
Inability to control response to trauma can result
in hyperemia, osteopenia, and osteoclastic bone
resorption
Charcot arthropathy
18. • Malnutrition:-
Adequate protein and energy is required for wound
healing
Screening test:
serum albumin
total lymphocyte count
Albumin less than 3.5 and lymphocytes less than
1,500 cells/ml is significant
19. • Etiology of Nonunion –
(Fracture/Injury Factors):-
High energy injury
Fracture mechanism
– MVC vs fall from standing
Open or closed fracture
Bone loss
Soft tissue injury
Bone involved and anatomic location
20. • Fracture Pattern:-
Fracture patterns in higher energy injuries (i.e.: comminution,
bone loss, or segmental patterns) have a higher degree of
soft tissue and bone ischemia
• Traumatic Soft Tissue Disruption:-
• Incidence of nonunion is
increased with open fractures
• More severe open fracture
(i.e. Gustillo III B vs Grade I)
have higher incidence of
nonunion
21. • Etiology of Nonunion –(Initial
Treatment Factors):-
Nonunion may occur after completely
appropriate treatment of a fracture, or after
less than appropriate treatment
Was appropriate management performed
initially?
Operative vs non-operative?
Was the stability achieved initially appropriate?
Consider:
Bone and anatomic location (shaft vs metaphysis)
Patient – host status, compliance with care
22. • Etiology of Nonunion –(Initial
Treatment Factors):-
After operative treatment…..
Was the appropriate implant and technique
employed? (Fixation strategy)
Relative vs absolute stability?
Direct vs indirect reduction?
Implant size/length, number of screws, locking vs
conventional
Location of incisions. Signs of poor dissection?
Iatrogenic soft tissue disruption, devascularization of bone
24. Etiology: Surgeon
Excessive soft tissue stripping
•Improper or unstable fixation
-Absolute stability-
• Gap due to distraction or poor reduction
-Relative stability =
Excessive motion
25. • Etiology of Nonunion –(Initial
Treatment Factors):-
Is the current construct too flexible or too stiff?
Implant too short?
Bridge plating of a simple pattern with lack of
compression?
Why did the current treatment fail?
Understanding the mode of failure for the initial
procedure helps with planning the nonunion
surgery
26. • Anatomic Location of
Fractures:-
Some areas of skeleton are at risk for nonunion
due to anatomic vascular considerations i.e.:
Proximal 5th metatarsal, femoral neck, carpal
scaphoid
Open diaphyseal tibia fractures are the classic
example with high rates of nonunion throughout
the literature
27. • Infection:-
May be obvious
Open draining wounds, erythema, inadequate soft tissue
coverage
Subclinical is more difficult
High index of suspicion
ESR, CRP may indicate infection and provide baseline
values to follow after debridement and antibiotic therapy
• Must be dealt with…..
• Debridement, debridement, debridement
• Multiple cultures. Identify the bacteria
• Infected bone requires stability to resolve infection
• May achieve union in the presence of infection with
appropriate treatment
28. • Evaluation OF PATIENTS:-
History of injury and prior treatment
Medical history and co-morbidities
Physical examination
Including deformity!
Imaging modalities
Patient needs, goals, expectations
29. • Patient Evaluation – History of
Injury:-
Date and nature of original injury (high or low
energy)
Open or closed injury?
Number of prior surgical procedures
History of drainage or wound healing difficulties?
Prior infection? Identify antibiotics used and
bacteria cultured (if possible)
Written timeline in complex cases
Current symptoms – pain, deformity, motion
problems, chronic drainage
Ability to work and perform ADL’s
30. • Patient Evaluation – Medical
History:-
Diabetes, endocrinopathies, vit D, etc
Physiologic age – co-morbidities
Heart disease, COPD, kidney/liver disease
Nutrition
Smoking
Medications
Ambulatory/functional status now and prior to
original injury
31. • Patient Evaluation –(Physical
Exam):-
Appearance of limb
Color, skin quality, prior incisions, skin grafts
Erythema or drainage
Range of motion of all joints
Pain – location and contributing factors
Strength, ability to bear weight
Vascular status and sensation (complete
neurovascular exam)
Deformity
Clinically = Length, alignment, AND rotation
32. • Patient Evaluation –(Imaging):-
Any injury-related imaging available – plain film
and CT
Serial plain radiographs from injury to present are
extremely helpful (hard to get)
Most current imaging – orthogonal x-rays, typically
diagnostic for nonunion
Healing of 3 out of 4 cortices without pain is typically
considered union.
Oblique view may be helpful for radiographic
diagnosis of nonunion
CT can be helpful but metal artifact can make it
difficult
33. • Patient Evaluation –(Imaging
Tomography):-
Linear tomograms
Helpful if metallic hardware present
Helps to identify persistent fracture line in:
Hyptrophic nonunions in which x-rays are
not diagnostic and pain persists at fracture
site
CT and MRI are replacing linear tomography
Still a good option if available at your
institution
34. • Patient Evaluation-
(Radionuclide Scanning):-
Technetium - 99 diphosphonate
Detects repairable process in bone ( not specific)
Gallium - 67 citrate
Accumulates at site of inflammation (not specific)
Sequential technetium or gallium scintigraphy
Only 50-60% accuracy in subclinical
ostoemyelitis
35. • Indium III - Labeled Leukocyte
Scan:- Infected Nonunion?
Good with acute osteomyelitis, but less
effective in diagnosing chronic or subacute
bone infections
Sensitivity 83-86%, specificity 84-86%
Technique is superior to technetium and
gallium to identify infection
36. MRI:- Infected Nonunion?
Abnormal marrow with increased signal on T2 and
low signal on T1
Can identify and follow sinus tacts and sequestrum
diagnostic sensitivity of 100%, specificity 63%,
accuracy 93%
37. Nonunion:-Diagnosis
• Persistent Pain
• Non physiologic motion
• Progressive deformity
• No radiographic evidence of healing
• Failing implants
38. • Patient Evaluation –(Goals &
Expectations):-
What are the patient’s goals and needs?
Household ambulation vs marathon runner
Pain relief expectations
Range of motion expectations
Long standing nonunions may have stiff adjacent
joints
Risks to neurovascular structures (radial nerve in
humerus nonunion)
41. Electrical Stimulation:-
Applied mechanical stress on bone generates
electrical potentials
Compression = electronegative potentials =
bone formation
Tension = electropositive potentials = bone
resorption
Basic science suggests e-stim upregulates
TGF-β and BMP’s suggesting osteoinduction
42. Three Modalities of Electric bone
Growth Stimulators:-
1. Direct current - implantation of cathode
in bone and anode on skin
2. Inductive coupling – pulsed
electromagnetic field with device on skin
3. Capacitive coupling - electrodes placed
on skin, alternating current
Conflicting and inconclusive evidence
44. Unanswered Questions:-??
When is electric stimulation indicated?
Which fracture types are indicated?
What are the efficacy rates?
What time after injury is best for
application?
45. Ultrasound:-
Piezoelectric transducer generates an acoustic
pressure wave
Some evidence to show faster healing in fresh
fractures
Evidence is moderate to poor in quality with
conflicting results
46. Extracorporeal Shock Wave
Therapy:-
Single impulse acoustic wave with a high
amplitude and short wavelength.
Microtrauma induced in bone thought to stimulate
neovascularization and cell differentiation
Clinical studies are of a poor level and no strong
evidence for use in nonunions is available
47. Operative Treatment:-
Debridement and hardware
removal
Plate osteosynthesis
Intramedullary nailing
External fixation
Autogenous bone graft
Bone marrow aspirate
Allograft bone
Demineralized bone matrix
BMP’s
Platelet concentrates
48. Autogenous Bone Marrow
Aspirate:-
Typically from the iliac crest
Transplant osteoprogenitor and mesenchymal
stem cells to nonunion site
Osteoinductive, not osteoconductive
Level III and IV studies available
Positive correlation between number of progenitor
cells in aspirate and amount of callous
49. BMP’s:-
rhBMP-2 and rhBMP-7 have been shown to be
equivalent to autologous iliac crest graft for
delayed reconstruction of tibial bone defects
May be a good alternative to ICBG for the
management of nonunion
Very expensive!!
rhBMP-2 inserted at the time of definitive wound closure for
high grade (3A or 3B) open tibia fractures- unclear effect on
re-operation and infection rates because literature conflicting
50. Autogenous Bone Grafting:-
Considered the “gold standard”
Osteoinductive - contain proteins and other factors
promoting vascular ingrowth and healing
Osteogenic – contains viable osteoblasts,
progenitor cells, mesenchymal stem cells
Osteoconductive - contains a scaffolding for which
new bone growth can occur
51. Surgical/Fixation Strategy:-
Define nonunion type
Hyper-, oligo-, atrophic, or pseudarthrosis
Fracture location – diaphysis vs metaphysis
Infected vs Aseptic
Deformity?
Patient/host factors
Goals and expectations
52. Plate Osteosynthesis:-
Correction of malalignment
Osteotomy may be required, planning always
required
Compression in hypertrophic cases
Immediate mobilization, likely NWB
Requires adequate soft tissue coverage
More dissection required for plating and
osteotomy in deformity correction
Bone graft as needed
53. Plate Osteosynthesis:-
Soft tissue and bony dissection are extremely
important!
Preserve periosteum and muscular
attachment to bone
Concept of “working window”
Only expose the necessary amount of bone
to do the case, maintain vascularity
54. Plate Osteosynthesis:
Osteoperiosteal Decortication
Management of the bone…
Do not simply elevate the periosteum off the
bone!!
Use a sharp chisel or osteotome to elevate an
osteoperiosteal flap
Sharp chisel and a mallet to take some good,
vascularized bone with the periosteum
Provides excellent environment for bone graft to
produce callous as the elevated bone remains
vascularized by the periosteum
55. Intramedullary Nailing:-
Mechanically stabilizes long bone nonunions as a
load sharing implant
May allow for early weight bearing
Must manage malalignment
Starting and ending points, entrance and exit
angle of each fragment
Initially destroys endosteal blood supply (will
recover) but increase periosteal blood supply
56. Intramedullary Nailing…
Can be performed without direct exposure or
dissection of the fracture soft tissue envelope
Or can be performed in conjunction with an open
exposure of the nonunion site and bone grafting
Not applicable in articular nonunions and
malunions
57. IM Nail Dynamization:-
Removal of interlocking bolt(s) to allow for axial
compression at nonunion with weight bearing
•Commonly performed technique for nonunion
management when IM nail is in place
•Extremely limited data to support this technique
•83% success rate in tibial nonunion management
58. IM Exchange Nailing:-
Replacing IM nail with larger IM nail increased
stability (r4)
•Medullary reaming reactive vascularity
•limited data to support this technique (stronger
than dynamization data)
•90% success rate in tibial nonunion management
59. External Fixation:-
Excellent for gradual malalignment correction
Useful in the management of infected nonunions
Allows for repeat debridements while providing stability
Soft tissue coverage without contaminated hardware in
wound
Allows for bone transport for large intercalary defects
Can generate large compressive forces at nonunion
Allows mobilization of joints
May be bulky and difficult for patients to manage
Pin infections common
In complex cases, may be good for limb salvage but may
require a long period of time
1.LRS technique(monorail)
2.Ilizarov technique
60. Nonunions:
(Summary)
• Definition of delayed unions/nonunions and
natural course of fracture healing
• Causes of disturbed bone healing such as
vascularity, instability, and infection
• Principles of treatment applied based on types of
nonunion:
- stabilization
- enhancement of biology
- eradication of infection if any
• How to prevent delayed unions/nonunions:
- biological fixation in original operation
- early recognition of delayed union