Nonunion Problems

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The nonunion of fractures is a well-known problem for centuries but fixing of the problem could not be succeeded until 1950s. An orthopedician, Prof. Dr. Gavril Abramovich Ilizarov discovered a technique for the management of ‘nonunions’ like as the discovery of insulin for diabetic patients.

The efficieny of Ilizarov method was better understood when nonunion fractures, which could not be fixed using former techniques, were healed and some famous people regained walking ability and their fractures were healed using Ilizarov then, the use of Ilizarov method became more prevalent.

In Ilizarov method, the surgeries are planned with various calculations beforehand and some of the external metal devices are the main components of the treatment. However, some people may find the devices scary.

The terms used for definition of nonunion of long bones must be known before the management procedures are explained. WHO(World Health Organisation) and Orthopedic literature define that; if a fracture does not reunion after 6 months or if the X-rays taken in consecutive 3 months reveal that there is no progress in reunion, it is called nonunion. The period may increase to 9 months due to the bone type and location of the fracture. Unless  the reunion is provided until 9 months, then a surgical intervention must be performed without any delay.

Nonunion of bone is defined as pseudoarthrosis. They are classified as atrophic, hypertrophic and infected pseudoarthrosis. Infected pseudoarthroses have been explained in chronic osteomyelitis section. Therefore, we will not mention in this section.

In atrophic pseudoarthrosis, the atrophic pseudoarthrosis region must be opened and epiphysis must be regenerated to enable the reunion because epiphyses are sclerotic. In addition, the fracture region must be strengthened by the bone autograft provided from the patient’s hip.

The implants inserted on fracture region may not be strong enough and broken or damaged before the fracture is healed in hypertrophic pseudoaarthrosis. The only difference than atrophic pseudoarthrosis is that, opening of the fracture region will not be necessary. Reunion can be enabled using particularly the circular fixator with the help of distraction osteogenesis. Distraction osteogenesis, which was introduced by Dr.Ilizarov, has been successfully used in both atrophic and hypretrophic pseudoarthrosis.