NONUNION OF FRACTURES CAUSES AND TREATMENT - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing causes and treatment of nonunion fractures.
In nonunion, the healing process of the fracture stops. Failure of fixation of the fracture indicates a nonunion.
Nonunion may be caused by excessive motion of the bony ends and incomplete healing of the fracture. We need stability of the fracture.
Fractures at risk for nonunion:
•Scaphoid
•Proximal femur/ femoral neck fracture
•Fifth metatarsal / Jones fracture
•Open fracture
•The tibia is the common bone to develop nonunion.
Types of nonunions
Hypertrophic “elephant foot”
•Vascular with abundant callus
•Result from inadequate immobilization or fixation.
Oligotrophic
•Vascular with no callus formation
•Not hypertrophic, but are vascular usually occurring after major displacement of a fracture.
Atrophic
•Avascular- no blood supply.
•The ends of the fragments have become osteoporotic and atrophic.
•This type requires bone graft in addition to stabilization of the fracture.
Common causes that may lead to nonunion:
•Smoking
•Diabetes
•Obesity
•Osteoporosis
•Unstable fixation
•Infection
•Open fracture (most common)
•Severe displacement of the fracture (most common)
•Cigarette smoking significantly reduces bone healing rate. Pseudoarthrosis is five times more common in smokers.
Treatment of nonunion
•Conservative treatment may be helpful yet controversial
•Bracing
•Electrical stimulation
•Most nonunions require surgical treatment
•If the ends of the bone appear avascular, then bone grafting may be necessity.
•The goal of surgical treatment is
1-Restore vascularity of the bone
2-Provide stability of the fracture with a plate or a rod
3-Create a healing response by using a bone graft or a bone graft substitute when needed.
•The ideal treatment for humeral shaft nonunion is a plate and bone graft.

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