Fracture Non-union

Fatigue Bone fracture site Implant screw hole Screw thread Early weight bearing Small size implant Unstable reduction Fracture non-union... 

The use of scintigraphy to diagnose infection in children should no longer be standard practice. Technetium 99 labelled methylene diphospho-nate is taken up by osteoblasts in areas of increased bone turnover, whether this be infection or trauma. Indium-111 labelled leukocyte scans are more specific because leukocytes are not involved in the normal bone healing response (Seabold 1991), but the radioactive dose is considerable. By combining technetium and indium labelled studies, it has been reported that sensitivity of 86% and specificity of 84% can be achieved when diagnosing infected fracture non-unions (Nepola 1993). 

Agrawal, C.M., Best, D., Heckraann, J.D., Boyan, B.D. (1995) Protein release kinetics of a biodegradable implant for fracture non-unions. Biomaterials, 16, 1255-1260. 

Screw thread Unstable reduction Fracture non-union... 

Hofmann, A., Ritz, U., Hessmann, M. H. et al. 2008. Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions. Bone, 42, 894-906. 

Dias JJ, Hui AC, Lamont AC (1994) Real time ultrasonography in the assessment of movement at the site of a scaphoid fracture non-union. J Hand Surg [Br] 19 498-504 Duncan 1, Sullivan P, Lomas F (1999) Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol 173 681-683... 

Very active researches concern this family of drug targets in the fields of cancer, angiogenesis and bone therapy. Dibotermin alfa (rhBMP2), a recombinant form of BMP is accepted for the treatment of acute tibia fractures in adults, as an adjunct to standard care using open fracture reduction and intramedullary nail fixation in patients in whom there is a substantial risk of non-union. Three platforms of TGF-(3... 

CT is also helpful to follow fracture healing, particularly when mal or non-union (Fig. 3.2), myositis ossificans or pseudarthrosis development are suspected on plain radiographs. Those fractures involving the epiphyseal (growth) plates have the potential to interfere with later growth. Bone bridge formation and its consequent deformities are easy to illustrate with CT. 

Fig. 3.2. Anterior oblique 3D VR image demonstrating non-union of a tibial diaphyseal fracture. For comparison, the adjacent fibular fracture has healed well and has started to re-model...

Highly comminuted or segmental fractures may require internal fixation because of their inherent instability (Fig. 8.9). Open reduction increases the risk of complications, particularly in the case of high energy injuries with severe soft tissue injury. Further insult in the form of surgery will increase the risk of infection and delayed/non-union. 

Fig. 8.15a-c. Oblique grade II open fracture of the tibia treated initially with external fixator, a An AP radiograph post-fixator removal is suggestive of non-union, b Coronal CT reconstruction demonstrates hypertrophic non-union after 5 months, c Union achieved with bone graft plus rigid internal fixation... 

Coxa vara occurs in approximately 10%-30% of hip fractures. It may be the result of insufficient reduction in the fracture, delayed or non-union, osteonecrosis or premature closure of the physeal plate. Severe coxa vara will result in limb length shortening and can lead to early osteonecrosis. Both coxa vara and non-union can be managed by subtrochanteric valgus osteotomy. 

The vascular supply to the dens is located above the synchondrosis and therefore, these fractures usually heal without any complications. In cases of non-union, the apical fragment continues to retain blood supply and forms a well defined rounded ossicle called the os odontoideum . Trauma is thought to be responsible for os odontoideum rather than... 

Chronic traumatic fracture in normal bone with non-union of fracture fragments or internal cystic... 

Solomon DH, Hochberg MC, Mogun H, Schneeweiss S. The relation between bisphosphonate use and non-union of fractures of the humerus in older adults. Osteoporos Lit 2009 20(6) 895-901. 

The hand and wrist are commonly fractured in falls on the outstretched arm. The ulna, the radius, or both are prone to break as an individual attempts to catch oneself when falling. Blows to the forearm or hand may result in fractures. A fracture of the scaphoid at the base of the anatomic snuffbox is one that is slow to heal or may result in non-union and must be watched carefully. 

Antibiotic-cement coatings can be used in different kinds of bone fractures, such as tibia, femur, etc. Usually when a fracture of long bones occurs, the treatment consists of the insertion of a rod (usually called intramedullary nail) in the intramedullary cavity. In case of infection, the treatment commonly includes removal of the nail, debridement and lavage of compromising tissue, and the use of a fixator at non-union site, and sometimes the use of antibiotic-loaded cement beads or rods [66]. 

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