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What is Non-Union

All over the world 5% to 7% of all fractures face some complications and result in damage. One of the most common complication is that of Non-union. This is a permanent failure of healing following a broken bone. Non-union is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected.

In general, if a Non-Union persists for 20 to 24 weeks post injury it will remain unhealed. The Non-Union fracture will need immediate surgical intervention which can be painful and require intensive rehabilitation, with no guarantees of success.

The common symptoms of Non-Unions are:

  • Pain on movements
  • Developing a deformity
  • Fracture site is mobile
  • No radiological signs of callus formation from x-ray and CT scan

Types of Non-unions

1. Hypertrophic Non-Union

Hypertrophic Non-Union fractures are typically caused by inadequate immobilization with adequate blood supply. They easily heal once mechanical stability is improved through the Illizarov apparatus. Hypertrophic Non-Union tissue plays an important role during the healing process by serving as a reservoir for mesenchymal cells that are capable of transforming into cartilage and bone-forming cells which help in regeneration.

2. Atropic Non-Union

Atropic Non-Union occur due to impaired bony healing. Atrophic Non-Union are treated by proper fixation, through the process of removing the end layer of bone to provide raw ends for healing, and with the help of bone grafts.

The common examples of Atropic Non-Unions:

  • Fractures associated with major soft tissue disruption (such as an open fracture where the bone is exposed to the outside environment) compound injuries
  • Fractures associated with a high velocity and high energy mechanism like road traffic accident and war / blast injuries.
  • Certain bones have their natural position in the body. For instance lower portion of leg as it has poor blood circulation.
  • Fractures in patients with metabolic disorders.
  • Congenital Pseudarthrosis

Treatment

Treatment is planned according to the type of Non-Union site and previous surgeries performed on the fractured bone keeping in mind all other aspects that may affect the treatment. In the broadest terms, the treatment plan should include a method of stimulating the regenerative process at the Non-Union site or improving the mechanical stability or both.

Stability can be provided with the help of plates and screws, nails, and external fixation devices.

  • Ilizarov method is the choice of treatment when stability and stimulation for union are needed. Research has shown a success rate of 99.5% using Illizarov apparatus
  • Some common treatment methods of stimulating regeneration include: bone grafting method, stem cell therapy, and/or bone substitutes.

With proper treatment, even the most complex and debilitating Non-Union fracture can be healed. Further improving and the patient’s quality and mobilizing him/her for a better future.

Result

Case 1

A case of gunshot injury-causing scarring and shortening of thigh length and union was achieved by applying illizarov fixator.

Case 2

Child suffering from Congenital Pseudarthrosis- Undergone Bone Transport

Case 3

A 62 years old woman suffering from Non-Union for 40 years and having undergone 4 failed surgeries

Case 4

Non-Union of the femur with broken screws fixed with specialized inflatable nail

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