Nonunion of fracture

Introduction to fracture nonunion Nonunion of the fracture is called nonunion. Bone tissue has the power to repair itself, and most fractures will heal well when the fracture is given proper treatment. However, some fractures are difficult to heal. When the fracture heals slowly, it is called delayed healing. When the fracture does not heal, it is called nonunion. About 5% of all fracture patients have difficulty healing. Due to the continuous activity of the fracture site, nonunion is usually accompanied by pain, which greatly reduces the quality of life of the patient. The factors affecting fracture healing are systemic and local factors. Systemic factors include the patient's metabolism, nutrition, health status, and activity. Another report said that smoking is also related to it. Local factors include: blood supply to the fracture, influence of infection, degree of soft tissue injury, soft tissue embedding at the fracture end, and treatment. The latter included repeated manual reductions, incision of soft tissue and exfoliation during open reduction, excessive traction during sustained bone traction, inaccurate fracture fixation, inappropriate functional exercise, and removal of open fractures during debridement. Excessive bones, etc. In addition to severe malnutrition, the effects of systemic factors on fracture healing are far less affected by local factors. basic knowledge The proportion of sickness: 0.6% Susceptible people: no specific people Mode of infection: non-infectious Complications: patellofemoral joint pain

Cause of fracture nonunion

Determining the cause of nonunion is the key to choosing a treatment. The most common causes of nonunion are as follows: infection, insufficient local blood supply, separation of fracture ends, and insufficient fracture stability.

Non-continuous bone can occur in any bone, but there are several places that are notorious for prone to nonunion. The reason is that the blood supply to these parts is poor. Including: scaphoid, talus, femoral neck, fifth metatarsal, middle and lower tibia.

Fractures in the following situations are also prone to nonunion:

The fracture combined with major soft tissue destruction (such as open fracture bone).

A fracture caused by a high-energy injury mechanism (such as a traffic accident or a fall from a height).

Older people or people with low immune function.

At the same time, the fractures of patients with metabolic bone disease are combined.

Fracture nonunion prevention

The bones are not attached to prevention. Emphasis on early prevention and elimination of adverse fracture healing factors will prevent the occurrence of nonunion.

1. When transporting the wounded, the fracture should be fixed properly to reduce the local trauma; also, when the manipulation is reset, the movement should be gentle to reduce the local trauma; severe trauma and excessive periosteal peeling will affect the bone healing.

2. Avoid gaps at the fracture end.

3, early reduction: after the fracture, there are many blood vessels in the state of twisted compression, local blood vessel embolism, will affect the local blood supply, so that the fracture healing is slow.

4. During the fixation of the fracture, attention should be paid to the non-braking joints.

5, try to use non-surgical reduction method: surgical reduction will inevitably damage the periosteum and local blood vessels, which will lead to slow fracture healing, but some fractures that do have soft tissue embedding still need surgical open reduction and internal fixation.

6, fixed to be perfect, time should be sufficient.

Fracture nonunion complications Complications, patellofemoral joint pain

1. Minhang: The nonunion caused by the femoral neck fracture, the femoral head can not fully support the whole weight, causing the patient to walk clearly, even losing the ability to walk, can only rely on a wheelchair or crutches, resulting in the loss of capacity of the patient.

2, muscle atrophy: unconnected fractures, there may be angulation, shortening and rotational deformity. Due to the inability to use the limb for a long time, joint contracture deformity and muscle atrophy can occur.

3. Pain: After the fracture, the pain occurs due to the fracture fracture. After the nonunion occurs, the fracture end can not heal. The patient also has pain when moving the affected limb or carrying weight, which causes many patients who are not connected to the bone to walk or move the affected limb.

Fracture non-healing symptoms Common symptoms Joint swelling and pain Joint deformity Joint pain Painful sulcus drooping gait gait persistent pain Tibial pain

1. Abnormal activity at the fracture end: When the fracture is more than 6 months, if there is abnormal activity during the fracture end activity examination, it can be diagnosed as nonunion.

2. Pain: Pain occurs when the bone ends move or when trying to load.

3, deformity and muscle atrophy: unconnected fractures, may have angulation, shortening and rotational deformity. Due to the inability to use the limb for a long time, joint contracture deformity and muscle atrophy can occur.

4. Loss of weight-bearing function: Loss of weight-bearing function after bone fracture, but some femoral neck fractures have lameness.

5, bone conduction sound reduction: bone non-continuous or delayed connection, bone conduction sound is weaker than the healthy side.

Unhealed fracture examination

1. Check: Whether there is abnormal activity at the fracture end, whether it is accompanied by pain, tenderness and conduction pain.

2, X-ray film: should pay attention to the degree of osteoporosis at the fracture end, with or without bone end sclerosis, atrophy of the bone end and medullary cavity closure, with or without pseudoarthrosis. X-ray photographs showed that the fracture ends were separated from each other, the gap was large, the bone ends were hardened, the atrophy was loose, and the medullary cavity was closed.

3, CT or nuclear magnetic resonance: imaging can be specified to a specific extent.

Diagnosis and diagnosis of fracture nonunion

1. Delayed juvenile osteoporosis: general osteoporosis, vertebral biconcave deformation or flat vertebral body, and lateral kyphosis and easy fracture of the spine, similar to osteogenesis imperfecta; but the latter still has a head Large, bilateral humerus external protrusion, flat skull base, small triangular face, blue sclera, multiple suture bones, and family history are different from the former. The diagnosis of type I OI is sometimes very difficult. I should think of type I OI in the case of osteoporosis in adolescents or severe osteoporosis in perimenopause.

2, osteomalacia and rickets: no bone brittle and easy to fold, no blue sclera, the front of the mineralization with a fuzzy brush or cup mouth, sputum cartilage disc widening, bone softening more common in pregnant or lactating women, with bone Pain, serum calcium, phosphorus are reduced.

3, vitamin C deficiency: patients also have osteoporosis, but subcutaneous, intermuscular, epithelial membrane may have bleeding points, may have severe pain and pseudonymia, calcification may occur after fracture healing.

4, osteosarcoma: osteogenesis in patients with fractures can occur a large number of osteophytes, most of which are benign, only a few have erythrocyte sedimentation and elevated blood ALP, if necessary, bone biopsy can be identified.

5. Hyperactivity of joints: Joint relaxation and hyperactivity are one of the characteristics of OI, and should be associated with other collagen-deficient diseases that cause this change, such as benign joint hyperactivity syndrome, Morquio syndrome, Ehlers-Danlos syndrome. , Marfan syndrome, Larsen syndrome, etc., in addition, special types of OI can be expressed as Cole-Carpenter syndrome, or adolescent osteoporosis, Ehlers-Danlos syndrome, OI combined with primary hyperparathyroidism, OI merger Dentinogenesis imperfecta (DI), OI-like syndrome, should be noted for identification.

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