Tibial shaft nonunion

Introduction The humeral shaft is not connected with the soft tissue of the humeral fracture. The trophoblastic artery and the nutrient vessels are vulnerable to injury. The lower fracture segment is insufficiently supplied with blood and is prone to fracture nonunion (nonunion). Poor local soft tissue conditions, long-term non-union of the soft tissue infection of the fracture or large scar formation will affect the blood supply at the fracture end, which is not conducive to fracture healing.

Cause

1 Local soft tissue effects: poor local soft tissue conditions, long-term non-union of the soft tissue infection of the fracture or large scar formation will affect the blood supply at the fracture end, which is not conducive to fracture healing. In this group, 1 case of middle tibiofibular fracture and 2 cases of middle and lower tibiofibular fractures were associated with poor soft tissue conditions, and all of them were successful in improving soft tissue replantation.

2 Respiratory disorders: fractures of the blood vessels often lead to nonunion, internal fixation plate filling, resulting in increased local internal pressure tension nourishing varicose compression, embolism, severe open fractures, soft tissue damage, soft tissue around the fracture Both vascular injury and blood vessel damage affect the fracture. Open fracture healing is slower than closed fracture, and the incidence of nonunion is also high, up to 5% to 17% [1]. Surgical incision and reduction, due to excessive periosteal dissection, the incidence of nonunion can be higher than 4 times of closed reduction [1], periosteum has a great effect on fractures, is the main source of bone cortex nutrition. The blood supply characteristics of the humeral shaft are so easy to occur after the lower third of the humerus fracture.

3 Infection: Occurred in open fractures (5% to 7%) or after surgery (1.2% to 3.8%); bloody infections in closed fractures were only 0.2%. Infection increases necrosis and absorption at the fracture end and vascular occlusion, and severe osteomyelitis leads to nonunion.

4 Improper fixation: 2 of the 6 open fractures in this group were associated with infection, and 1 of them developed osteomyelitis. Therefore, infection is an important cause of nonunion, called infectious nonunion. The purpose of fracture fixation is not only to maintain good contact at the fracture end, but also to eliminate stresses that are not conducive to fracture healing, namely muscle contraction force, limb gravity, shear force generated during activity, and rotational stress. There are 3 kinds of bad conditions fixed in this group:

(1) Non-surgical treatment is performed by external fixation after plastering, and the fracture end dislocation is not replaced by gypsum or splint after the swelling is removed; (2) the fixed plate is too short, and the ratio of the length of the plate to the diameter of the fracture is less than 4 times. The diameter of the saw needle is smaller than the diameter of the fractured medullary cavity itself, resulting in the separation of the fracture rotation;

(3) Improper postoperative treatment, premature removal of internal fixation, irrational functional exercise, so that the fracture end separation and internal fixation loosening to cause bone nonunion. In this group of 15 patients, 7 patients were found to have nonunion due to poor fixation, accounting for 46.7%. Therefore, unreasonable fixation is the main cause of nonunion, called iatrogenic nonunion.

an examination

Related inspection

X-ray examination of mammography

Symptoms: fractures are not connected

X-ray examination is of great value in the diagnosis and treatment of fractures:

All patients with suspected fractures should be routinely X-ray film examination, which can be found in clinically difficult to find incomplete fractures, deep fractures, intra-articular fractures and small avulsion fractures, even if they have clinically manifested as obvious fractures. X-ray film examination is also necessary to help understand the type and specific conditions of the fracture, and has guiding significance for treatment.

X-ray films should include positive and lateral positions, and the wells must include adjacent joints, and sometimes x-rays of oblique, tangent or corresponding parts of the contralateral side must be added. After reading the x-rays carefully, you should identify the following points:

(1) The fracture is invasive or pathological.

(2) Whether the fracture is displaced and how to shift.

(3) Whether the fracture alignment is satisfactory to the line and whether it needs to be rectified.

(4) Whether the fracture is fresh or old.

(5) Whether there is damage to the joint or bone injury.

Differential diagnosis

Differential diagnosis of nonunion of the humerus:

1. Patellar pseudoarthrosis: Congenital sacral pseudoarthrosis is a general term for congenital tibia formation or failure. There are many specific types. Each type has its own pathology, disease course and prognosis. It is more common in the lower third of the humerus. At the junction, a local pseudo joint is eventually formed. The incidence rate of males is slightly higher than that of females, mostly unilateral, and the ipsilateral tibia can also be involved. A small number of patients have a genetic history.

2, humeral pain: "sacral pain" is a very widely used term, can be used to describe a variety of calf injuries. The patella pain described herein specifically refers to the inflammation described above.

3, humeral tenderness: tibia tenderness is an early signal of blood disease, one of the early phenomena of blood disease.

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