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Hierholzer, Christian; Bühren, Volker (2015). Nonunion. In: Rommens, Pol M; Hessmann, Martin H. Intramedullary Nailing : A Comprehensive Guide. Springer Berlin, Heidelberg New York: Springer, 419-452.

Abstract

The pathogenesis of bone healing disturbances is multifactorial, but especially related to impaired biology, inadequate stability, fracture gapping and infection. The key symptom is pain and discomfort at the site of nonunion while moving and weight-bearing the affected limb. Typical findings on conventional radiographs or CT support the diagnosis: missing progress of bone healing on serial images, loss of bridging trabecular bone crossing the fracture zone or hypertrophic bridging callus with persistent fracture gap. Breakage of implants is an additional, associated sign. Treatment principles consist of improvement of impaired biology and improvement of stability: restoration of axial alignment, stabilization of fracture fragments, reaming, intramedullary nailing with an increased nail diameter, compression of nonunion; and multiple interlocking. The authors prefer antegrade nailing with the patient in lateral position in femur diaphysis nonunion. Overreaming, exact positioning of the nail and interfragmentary compression are most important parts of the procedure. Exchange nailing is done as a closed procedure in hypertrophic nonunion of the tibia. For axis correction and in atrophic nonunion, the nonunion site is opened. Whenever an intact fibula blocks dynamization of the tibia, or compression across the tibial nonunion site, oblique fibula osteotomy and resection of a short segment is performed. Humerus nonunion after conservative treatment is treated with closed nailing, nonunion after nailing is treated with reaming, exchange nailing, compression and multiple interlocking. In metaphyseal nonunion, the use of an auxiliary plate; and in long oblique fractures, the use of cerclage wires is beneficial to secure fracture reduction during nail insertion and enhance stability of the nail-bone construct.

Abstract

The pathogenesis of bone healing disturbances is multifactorial, but especially related to impaired biology, inadequate stability, fracture gapping and infection. The key symptom is pain and discomfort at the site of nonunion while moving and weight-bearing the affected limb. Typical findings on conventional radiographs or CT support the diagnosis: missing progress of bone healing on serial images, loss of bridging trabecular bone crossing the fracture zone or hypertrophic bridging callus with persistent fracture gap. Breakage of implants is an additional, associated sign. Treatment principles consist of improvement of impaired biology and improvement of stability: restoration of axial alignment, stabilization of fracture fragments, reaming, intramedullary nailing with an increased nail diameter, compression of nonunion; and multiple interlocking. The authors prefer antegrade nailing with the patient in lateral position in femur diaphysis nonunion. Overreaming, exact positioning of the nail and interfragmentary compression are most important parts of the procedure. Exchange nailing is done as a closed procedure in hypertrophic nonunion of the tibia. For axis correction and in atrophic nonunion, the nonunion site is opened. Whenever an intact fibula blocks dynamization of the tibia, or compression across the tibial nonunion site, oblique fibula osteotomy and resection of a short segment is performed. Humerus nonunion after conservative treatment is treated with closed nailing, nonunion after nailing is treated with reaming, exchange nailing, compression and multiple interlocking. In metaphyseal nonunion, the use of an auxiliary plate; and in long oblique fractures, the use of cerclage wires is beneficial to secure fracture reduction during nail insertion and enhance stability of the nail-bone construct.

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Additional indexing

Item Type:Book Section, not refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2015
Deposited On:07 Jan 2016 07:16
Last Modified:08 Dec 2017 16:36
Publisher:Springer
ISBN:978-1-4471-6612-2
Publisher DOI:https://doi.org/10.1007/978-1-4471-6612-2_25
Related URLs:http://doi.org/10.1007/978-1-4471-6612-2 (Publisher)
http://www.springer.com/us/book/9781447166115 (Publisher)

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