355:
531:
438:
including the age and general health of the patient, the time since the original injury, the number of previous surgeries, smoking history, the patient's ability to cooperate with the treatment. In the region of 80% of nonunions heal after the first operation. The success rate with subsequent surgeries is less.
296:
In a hypertrophic nonunion, the fracture site contains adequate blood supply but the fracture ends fail to heal together. X-rays show abundant callus formation. This type of nonunion is thought to occur when the body has adequate biology, such as stem cells and blood supply, but inadequate stability,
428:
waves has been suggested to reduce the healing time for non-union fractures. The proposed mechanism of action is by stimulating osteoblasts and other proteins that form bones using these modalities. The evidence supporting the use of ultrasound and shockwave therapy for improving unions is very weak
345:
A diagnosis of nonunion is made when the clinician feels there will be no further bone healing without intervention. The FDA defines it as a fracture at least 9 months old that has not shown any signs of radiographic healing within the last 3 months. CT scans offer a closer look at the fracture and
437:
By definition, a nonunion will not heal if left alone. Therefore, the patient's symptoms will not be improved and the function of the limb will remain impaired. It will be painful to bear weight on it and it may be deformed or unstable. The prognosis of nonunion if treated depends on many factors
407:
revolutionized the treatment of recalcitrant nonunions demonstrating that the affected area of the bone could be removed, the fresh ends "docked" and the remaining bone lengthened using an external fixator device. The time course of healing after such treatment is longer than normal bone healing.
398:
Bone graft substitutes. Inorganic bone substitutes may be used to complement or replace autologous bone grafting. The advantage is that there is no morbidity on sampling and their availability is not restricted. S53P4 bioactive glass has shown good results as a promising bone graft substitute in
143:
Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in very few cases. In general, if a nonunion is still evident at 6 months post-injury it will remain unhealed without specific treatment, usually
346:
may also be used to evaluate how much of the fracture has healed. Blood tests can evaluate if the patient has adequate levels of nutrients such as calcium and vitamin D. Blood tests can also look for markers of infection such as ESR and CRP.
1201:
325:, may also lead to an atrophic non-union. Atrophic non-unions can be treated by stimulating blood flow and encouraging healing. This is often done surgically by removing the end layer of bone to provide raw ends for healing and the use of
337:
As the name implies, an oligotrophic nonunion demonstrates some attempt by the body to heal the fracture. These are thought to arise from adequate biology but displacement at the fracture site.
370:
Currently, there are different strategies to augment the bone-regeneration process, however, there is no standardised clinical treatment guideline yet. Surgical treatment options include:
1060:
160:
is usually apparent. The patient complains of persistent pain at the fracture site and may also notice abnormal movement or clicking at the level of the fracture. An
921:"The Use of Bioactive Glass S53P4 as Bone Graft Substitute in the Treatment of Chronic Osteomyelitis and Infected Non-Unions – a Retrospective Study of 50 Patients"
168:
formation may be evident but callus does not bridge across the fracture. If there is doubt about the interpretation of the x-ray, stress x-rays, tomograms or
391:. Filling of the bone defect resulting from debridement must be performed. Autologous bone graft is the "gold standard" treatment and possesses osteogenic,
1259:
1492:
297:
meaning the bone ends are moving too much. Typically, the treatment consists of increasing stability of the fracture site with surgical implants.
1690:
524:
374:
Debridement: radical surgical removal of necrotic or infected soft tissue and bone tissue is deemed essential for the healing process.
726:"Atrophic, aseptic, tibial nonunion: how effective is modified Judet's osteoperiosteal decortication technique and buttress plating?"
305:
In an atrophic nonunion, x-rays show little to no callus formation. This is usually due to impaired bony healing, for example due to
1178:
703:
480:
54:
573:
McCoy, Thomas H.; Fragomen, Austin T.; Hart, Kamber L.; Pellegrini, Amelia M.; Raskin, Kevin A.; Perlis, Roy H. (January 2019).
385:. Metal plates, pins, screws, and rods, that are screwed or driven into a bone, are used to stabilize the broken bone fragments.
1553:
1252:
1487:
1076:"Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis"
93:
unless intervention (such as surgery) is performed. A fracture with nonunion generally forms a structural resemblance to a
1522:
203:
soft-tissue imposition (there is muscle or ligament covering the broken ends and preventing them from touching each other)
1702:
429:
and it is likely that these approaches do not make a clinically significant difference for a delayed union or non-union.
1517:
140:. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is interrupted or stalled.
395:, and osteoconductive properties, although only a limited sample can be taken and there is a high risk of side effects.
783:
1418:
1245:
1446:
1658:
1512:
169:
1608:
1480:
1307:
1220:
447:
237:
118:
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1814:
1369:
1326:
1075:
129:
1383:
1296:
1819:
1624:
1401:
1054:
919:
Malat, Tarek Al; Glombitza, Martin; Dahmen, Janosch; Hax, Peter-Michael; Steinhausen, Eva (April 2018).
165:
1541:
1497:
724:
Binod, Bijukachhe; Nagmani, Singh; Bigyan, Bhandari; Rakesh, John; Prashant, Adhikari (August 2016).
1707:
1456:
1118:
Searle, Henry Kc; Lewis, Sharon R.; Coyle, Conor; Welch, Matthew; Griffin, Xavier L. (2023-03-03).
1074:
Leighton, R.; Watson, J.T; Giannoudis, P.; Papakostidis, C.; Harrison, A.; Steen, R.G. (May 2017).
230:
841:"Chronic osteomyelitis: THE EFFECT OF THE EXTENT OF SURGICAL RESECTION ON INFECTION-FREE SURVIVAL"
516:
399:
treatment of nonunions, due to its osteostimulative, osteoconductive and antimicrobial properties.
1529:
1475:
956:
882:"Autologous iliac crest bone graft: Should it still be the gold standard for treating nonunions?"
881:
761:
184:
145:
1722:
496:
113:, meaning joint). The diagnosis is generally made when there is no healing between two sets of
1717:
1268:
1157:
1139:
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983:
948:
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699:
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651:
612:
594:
476:
466:
382:
378:
69:
974:
Niedzielski K, Synder M (2000). "The treatment of pseudarthrosis using the
Ilizarov method".
920:
1736:
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90:
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816:
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392:
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535:
358:
194:
94:
765:
1586:
1548:
1413:
1396:
1391:
1354:
1276:
1135:
857:
840:
799:
575:"Genomewide Association Study of Fracture Nonunion Using Electronic Health Records"
548:
409:
86:
1225:
1095:
897:
164:
plate of the fractured bone shows a persistent radiolucent line at the fracture.
1364:
1312:
326:
322:
74:
31:
632:"The Normal Microcirculation of Diaphyseal Cortex and Its Response to Fracture"
1595:
1441:
1408:
1347:
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1214:
1210:
741:
425:
388:
35:
1143:
1028:
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within 3 months, but the treatment may continue for many months beyond that.
17:
1535:
1019:
310:
137:
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952:
905:
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757:
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616:
936:
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314:
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223:
132:
of a fracture and may occur when the fracture moves too much, has a poor
1193:
590:
318:
190:
the two ends are not apposed (that is, they are not next to each other)
122:
103:
1001:
Victoria, Galkowski; Petrisor, Brad; Drew, Brian; Dick, David (2009).
1451:
1205:
321:). Failure of initial union, as when bone fragments are separated by
53:
1697:
353:
200:
the fracture is not fixed (that is, the two ends are still mobile)
161:
148:. A non-union which does go on to heal is called a delayed union.
133:
62:
534:
This article incorporates text from this source, which is in the
1120:"Ultrasound and shockwave therapy for acute fractures in adults"
517:"Questions and Answers about Osteonecrosis (Avascular Necrosis)"
1241:
839:
Simpson, A. H. R. W.; Deakin, M.; Latham, J. M. (April 2001).
1003:"Bone stimulation for fracture healing: What′s all the fuss?"
309:
causes (e.g. impaired blood supply to the bone fragments) or
108:
403:
In simple cases, healing may be evident within 3 months.
288:
There are typically three types of nonunion described.
845:
The
Journal of Bone and Joint Surgery. British Volume
475:(2 ed.). Springer Science & Business Media.
1183:
473:
AO/ASIF Instruments and
Implants: A Technical Manual
1759:
1733:
1676:
1667:
1649:
1642:
1617:
1594:
1585:
1465:
1432:
1382:
1323:
1293:
1284:
1275:
1187:
97:, and is therefore often called a "false joint" or
68:
46:
187:(the blood supply was interrupted by the fracture)
361:pseudarthrosis before and after surgical fixation
925:Zeitschrift für Orthopädie und Unfallchirurgie
682:Brinker, Mark R.; O'Connor, Daniel P. (2009),
1253:
1059:: CS1 maint: DOI inactive as of April 2024 (
788:Clinical Cases in Mineral and Bone Metabolism
471:Rigmor Texhammar, Christopher Colton (2013).
8:
1124:The Cochrane Database of Systematic Reviews
1673:
1646:
1591:
1290:
1281:
1260:
1246:
1238:
1184:
730:Archives of Orthopaedic and Trauma Surgery
43:
1151:
1094:
1036:
1018:
856:
815:
606:
30:For the meaning in organized labour, see
27:Failure of a bone to heal after breakage
1493:Hypertrophic pulmonary osteoarthropathy
636:The Journal of Bone & Joint Surgery
459:
1052:
630:RHINELANDER, FREDERIC W. (June 1968).
125:. This is generally after 6–8 months.
7:
880:Sen, M.K.; Miclau, T. (March 2007).
777:
775:
677:
675:
673:
553:The Lecturio Medical Concept Library
377:Immobilization of the fracture with
277:Improperly applied fixation devices.
527:from the original on 9 August 2017.
696:10.1016/b978-1-4160-2220-6.10022-2
25:
648:10.2106/00004623-196850040-00016
529:
52:
1554:Infantile cortical hyperostosis
229:Metabolic disturbances such as
180:The reasons for non-union are:
1488:Complex regional pain syndrome
1136:10.1002/14651858.CD008579.pub4
1007:Indian Journal of Orthopaedics
858:10.1302/0301-620X.83B3.0830403
690:, Elsevier, pp. 615–707,
497:"Nonunions - OrthoInfo - AAOS"
263:Damage of surrounding muscles.
248:Related to the fracture site:
172:may be used for confirmation.
1:
420:Bone stimulation with either
61:Hypertrophic nonunion of the
1096:10.1016/j.injury.2017.05.016
898:10.1016/j.injury.2007.02.012
800:10.11138/ccmbm/2017.14.1.186
408:Usually, there are signs of
274:Insufficient immobilization.
236:Can be found in those with
1836:
1691:Legg–Calvé–Perthes disease
268:Related to the treatment:
254:Bone loss at the fracture.
251:Soft tissue interposition.
29:
1659:Osteochondritis dissecans
742:10.1007/s00402-016-2488-7
60:
51:
1703:Osgood–Schlatter disease
1609:Relapsing polychondritis
1481:Osteonecrosis of the jaw
1308:Osteitis fibrosa cystica
448:Distraction osteogenesis
226:and alcohol consumption.
219:Poor nutritional status.
193:infection (particularly
85:is permanent failure of
1419:Paget's disease of bone
1370:Vertebral osteomyelitis
1023:(inactive 2024-04-24).
1020:10.4103/0019-5413.50844
976:Ortop Traumatol Rehabil
243:Genetic predisposition.
213:Related to the person:
109:
1269:Bone and joint disease
362:
128:Nonunion is a serious
1749:Scheuermann's disease
1625:Slipping rib syndrome
1447:Hajdu–Cheney syndrome
937:10.1055/s-0043-124377
357:
333:Oligotrophic nonunion
292:Hypertrophic nonunion
271:Inadequate reduction.
260:Loss of blood supply.
107:, meaning false, and
1542:Aneurysmal bone cyst
1498:Nonossifying fibroma
782:Calori, Gm (2017).
231:hyperparathyroidism
1774:Kienböck's disease
1530:Skeletal fluorosis
1476:Avascular necrosis
591:10.1002/jbm4.10063
363:
185:avascular necrosis
152:Signs and symptoms
146:orthopedic surgery
1802:
1801:
1798:
1797:
1794:
1793:
1638:
1637:
1581:
1580:
1513:Fibrous dysplasia
1378:
1377:
1235:
1234:
383:external fixation
301:Atrophic nonunion
284:Types of nonunion
80:
79:
41:Medical condition
16:(Redirected from
1827:
1764:
1740:
1708:Blount's disease
1681:
1674:
1647:
1592:
1457:Gorham's disease
1424:Hypophosphatasia
1331:
1301:
1291:
1282:
1262:
1255:
1248:
1239:
1185:
1166:
1165:
1155:
1115:
1109:
1108:
1098:
1089:(7): 1339–1347.
1080:
1071:
1065:
1064:
1058:
1050:
1040:
1022:
998:
992:
991:
971:
965:
964:
916:
910:
909:
877:
871:
870:
860:
836:
830:
829:
819:
779:
770:
769:
736:(8): 1069–1076.
721:
715:
714:
713:
712:
679:
668:
667:
627:
621:
620:
610:
570:
564:
563:
561:
559:
545:
539:
533:
532:
528:
523:. October 2015.
513:
507:
506:
504:
503:
493:
487:
486:
464:
416:Bone stimulation
405:Gavriil Ilizarov
112:
56:
44:
21:
1835:
1834:
1830:
1829:
1828:
1826:
1825:
1824:
1805:
1804:
1803:
1790:
1760:
1755:
1734:
1729:
1723:Sever's disease
1677:
1663:
1651:Osteochondritis
1634:
1630:Tietze syndrome
1613:
1604:Costochondritis
1577:
1573:Pycnodysostosis
1508:Stress fracture
1461:
1434:Bone resorption
1428:
1374:
1324:
1319:
1294:
1271:
1266:
1236:
1231:
1230:
1196:
1175:
1170:
1169:
1130:(3): CD008579.
1117:
1116:
1112:
1078:
1073:
1072:
1068:
1051:
1000:
999:
995:
973:
972:
968:
918:
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913:
879:
878:
874:
838:
837:
833:
781:
780:
773:
723:
722:
718:
710:
708:
706:
688:Skeletal Trauma
681:
680:
671:
629:
628:
624:
572:
571:
567:
557:
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549:"Osteomyelitis"
547:
546:
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515:
514:
510:
501:
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470:
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422:electromagnetic
418:
368:
352:
343:
335:
303:
294:
286:
210:
178:
156:A history of a
154:
136:supply or gets
115:medical imaging
99:pseudoarthrosis
42:
39:
28:
23:
22:
15:
12:
11:
5:
1833:
1831:
1823:
1822:
1817:
1815:Bone fractures
1807:
1806:
1800:
1799:
1796:
1795:
1792:
1791:
1789:
1788:
1787:
1786:
1784:Panner disease
1778:
1777:
1776:
1767:
1765:
1757:
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1754:
1753:
1752:
1751:
1743:
1741:
1731:
1730:
1728:
1727:
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1725:
1720:
1718:Köhler disease
1712:
1711:
1710:
1705:
1695:
1694:
1693:
1684:
1682:
1671:
1665:
1664:
1662:
1661:
1655:
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1644:
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1636:
1635:
1633:
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1627:
1621:
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1615:
1614:
1612:
1611:
1606:
1600:
1598:
1589:
1583:
1582:
1579:
1578:
1576:
1575:
1570:
1569:
1568:
1566:Melorheostosis
1561:Osteosclerosis
1558:
1557:
1556:
1546:
1545:
1544:
1532:
1527:
1526:
1525:
1520:
1510:
1505:
1503:Pseudarthrosis
1500:
1495:
1490:
1485:
1484:
1483:
1478:
1469:
1467:
1463:
1462:
1460:
1459:
1454:
1449:
1444:
1438:
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1429:
1427:
1426:
1421:
1416:
1411:
1406:
1405:
1404:
1394:
1388:
1386:
1380:
1379:
1376:
1375:
1373:
1372:
1367:
1362:
1360:Brodie abscess
1357:
1352:
1351:
1350:
1345:
1334:
1332:
1321:
1320:
1318:
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1316:
1315:
1304:
1302:
1288:
1279:
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1272:
1267:
1265:
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1257:
1250:
1242:
1233:
1232:
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1217:
1197:
1192:
1191:
1189:
1188:Classification
1182:
1181:
1174:
1173:External links
1171:
1168:
1167:
1110:
1066:
993:
966:
931:(2): 152–159.
911:
892:(1): S75–S80.
872:
851:(3): 403–407.
831:
794:(2): 186–188.
771:
716:
704:
669:
642:(4): 784–800.
622:
565:
540:
508:
488:
481:
458:
457:
455:
452:
451:
450:
443:
440:
434:
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393:osteoinductive
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1371:
1368:
1366:
1363:
1361:
1358:
1356:
1353:
1349:
1346:
1344:
1341:
1340:
1339:
1338:Osteomyelitis
1336:
1335:
1333:
1330:
1328:
1322:
1314:
1311:
1310:
1309:
1306:
1305:
1303:
1300:
1298:
1292:
1289:
1287:
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1274:
1270:
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1243:
1240:
1227:
1223:
1222:
1218:
1216:
1212:
1208:
1207:
1203:
1199:
1198:
1195:
1190:
1186:
1180:
1177:
1176:
1172:
1163:
1159:
1154:
1149:
1145:
1141:
1137:
1133:
1129:
1125:
1121:
1114:
1111:
1106:
1102:
1097:
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1820:Osteopathies
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1549:Hyperostosis
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1414:Osteomalacia
1397:Osteoporosis
1392:Bone density
1355:Sesamoiditis
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208:Risk factors
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130:complication
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101:(from Greek
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89:following a
82:
81:
1523:Polyostotic
1365:Periostitis
1313:Brown tumor
982:(3): 46–8.
684:"Nonunions"
327:bone grafts
323:soft tissue
158:broken bone
91:broken bone
75:Orthopedics
32:Trade union
1809:Categories
1596:Chondritis
1518:Monostotic
1472:Ischaemia
1442:Osteolysis
1409:Osteopenia
1348:Involucrum
1343:Sequestrum
711:2021-10-07
502:2018-09-02
454:References
426:ultrasound
257:Infection.
117:, such as
36:Union shop
1536:bone cyst
1384:Metabolic
1327:infection
1297:endocrine
1144:1469-493X
1029:0019-5413
961:263428196
945:1864-6697
867:0301-620X
808:1971-3266
750:1434-3916
656:0021-9355
599:2473-4039
579:JBMR Plus
558:26 August
433:Prognosis
350:Treatment
341:Diagnosis
311:metabolic
222:Habitual
110:arthrosis
70:Specialty
1643:Combined
1402:Juvenile
1162:36866917
1105:28532896
1047:19838359
988:18034140
953:29665602
906:17383488
826:29263731
766:25366783
758:27317343
617:30680360
525:Archived
467:Page 542
442:See also
379:internal
359:Scaphoid
315:diabetes
307:vascular
224:nicotine
216:Old age.
138:infected
83:Nonunion
47:Nonunion
1226:D005599
1153:9983300
1038:2762251
817:5726207
664:5658563
608:6339539
366:Surgery
319:smoking
170:CT scan
123:CT scan
104:pseudo-
87:healing
1780:elbow
1770:wrist
1452:Ainhum
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1083:Injury
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176:Causes
166:Callus
1737:spine
1714:foot
1698:tibia
1669:Child
1618:Other
1587:Joint
1466:Other
1215:M96.0
1211:M84.1
1079:(PDF)
957:S2CID
762:S2CID
521:NIAMS
410:union
162:X-ray
134:blood
119:X-ray
63:tibia
1762:arm:
1687:hip
1679:leg:
1277:Bone
1221:MeSH
1179:AAOS
1158:PMID
1140:ISSN
1128:2023
1101:PMID
1061:link
1043:PMID
1025:ISSN
984:PMID
949:PMID
941:ISSN
902:PMID
863:ISSN
849:83-B
822:PMID
804:ISSN
754:PMID
746:ISSN
700:ISBN
660:PMID
652:ISSN
613:PMID
595:ISSN
560:2021
477:ISBN
469:in:
34:and
1202:ICD
1148:PMC
1132:doi
1091:doi
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603:PMC
587:doi
424:or
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317:or
238:NF1
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