NONUNION OF FRACTURES CAUSES, TYPES AND TREATMENT

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Definition and Overview:
In nonunion, the healing process of the fracture stops, and the fracture fails to heal completely.
Failure of fixation of the fracture indicates nonunion.
Nonunion may be caused by excessive motion of the bony ends and incomplete healing.
Stability is crucial for fracture healing.
Fractures at Risk for Nonunion:

Scaphoid
Proximal femur/femoral neck fracture
Fifth metatarsal (Jones fracture)
Open fractures
Tibia (the most common bone to develop nonunion)
Types of Nonunions:

Hypertrophic ("Elephant Foot"):

Vascular with abundant callus formation.
Caused by inadequate immobilization or fixation.
Oligotrophic:

Vascular with no callus formation.
Typically occurs after major displacement of a fracture.
Atrophic:

Avascular with no blood supply.
Ends of the bone fragments become osteoporotic and atrophic.
Requires bone grafting in addition to stabilization.
Common Causes of Nonunion:

Smoking (pseudoarthrosis is five times more common in smokers).
Diabetes.
Obesity.
Osteoporosis.
Unstable fixation.
Infection.
Open fractures (most common).
Severe displacement of fractures (most common).
Treatment of Nonunion:

Conservative Treatment:

May be helpful but is controversial.
Includes bracing and electrical stimulation.
Surgical Treatment:

Most nonunions require surgery.
If the bone ends are avascular, bone grafting is necessary.
The goals of surgical treatment are:
Restore vascularity of the bone.
Provide stability to the fracture with a plate or rod.
Create a healing response using a bone graft or substitute when needed.
Specific Treatment Example:

The ideal treatment for humeral shaft nonunion is a plate combined with bone grafting.
Quizzes
1. What is the most common bone associated with nonunion?

Scaphoid
Tibia
Humerus
Radius
Correct Answer: Tibia
Explanation: The tibia is the most common bone to develop nonunion due to its poor vascular supply and common association with open fractures.
2. Which type of nonunion is characterized by vascularity but no callus formation?

Hypertrophic
Atrophic
Oligotrophic
Malunion
Correct Answer: Oligotrophic
Explanation: Oligotrophic nonunions are vascular but do not produce a callus and are usually caused by major fracture displacement.
3. What is the primary goal of surgical treatment in nonunion?

Increase callus formation
Stabilize the fracture and restore vascularity
Remove the fractured bone
Use electrical stimulation
Correct Answer: Stabilize the fracture and restore vascularity
Explanation: The main goal of surgical treatment is to restore blood supply, stabilize the fracture, and initiate a healing response using grafting when needed.