- Discussion:
- hypertrophic non unions are rich in callus and have a rich blood supply in the ends of the fragments;
- they result from insecure fixation (inadequate stability) or premature wt bearing in a reduced fracture whose fragments are viable;
- fracture is capable of mounting a healing response to injury
- hypertrophic nonunion displays exuberant callus on radiographs
- there is increased uptake on radionuclide scans;
- management:
- may have high incidence of union after rigid ORIF compression plates or medullary nails, and cancellous bone grafts are optional;
- handling of the non union site:
- note that fibrous scar tissue connecting the bone ends of a hypertrophic nonunion has the capacity to turn into bone;
- if angulatory deformity is not present, these nonunions do not have to be opened and debrided (w/ angulatory deformity open debridement
of the frx may be necessary because of stiffness and resistance to correction);
- hence debriding the nonunion to excise the fibrous tissue between the bone ends is not required;
- opening the medullary canal proximally and distally may promote healing w/o taking down a firm fibrous union;
- references:
- Technique to Prepare the Bed for Autologous Bone Grafting in Nonunion Surgery
- Judet decortication and compression plate fixation of long bone non-union: Is bone graft necessary?
- Judet osteoperiosteal decortication for treatment of non-union: the Cornwall experience
- reaming:
- in many cases, however, the medullary canal of the non union site will not allow nail passage and therefore reaming is required;
- if reaming is to be performed, then consider opening frx site and reaming under direct vision since it is possible that blind reaming will
result in eccentric reaming and cortical perforation;
- plate fixation:
- providing adequate fracture stability may be all that is necessary to induce fracture stability;
- references:
- Judet decortication and compression plate fixation of long bone non-union: Is bone graft necessary?
- Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
- external fixation:
- references:
- Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus.
- Mechanical and biological treatment of long bone non-unions.
- hypertrophic non unions are rich in callus and have a rich blood supply in the ends of the fragments;
- they result from insecure fixation (inadequate stability) or premature wt bearing in a reduced fracture whose fragments are viable;
- fracture is capable of mounting a healing response to injury
- hypertrophic nonunion displays exuberant callus on radiographs
- there is increased uptake on radionuclide scans;
- management:
- may have high incidence of union after rigid ORIF compression plates or medullary nails, and cancellous bone grafts are optional;
- handling of the non union site:
- note that fibrous scar tissue connecting the bone ends of a hypertrophic nonunion has the capacity to turn into bone;
- if angulatory deformity is not present, these nonunions do not have to be opened and debrided (w/ angulatory deformity open debridement
of the frx may be necessary because of stiffness and resistance to correction);
- hence debriding the nonunion to excise the fibrous tissue between the bone ends is not required;
- opening the medullary canal proximally and distally may promote healing w/o taking down a firm fibrous union;
- references:
- Technique to Prepare the Bed for Autologous Bone Grafting in Nonunion Surgery
- Judet decortication and compression plate fixation of long bone non-union: Is bone graft necessary?
- Judet osteoperiosteal decortication for treatment of non-union: the Cornwall experience
- reaming:
- in many cases, however, the medullary canal of the non union site will not allow nail passage and therefore reaming is required;
- if reaming is to be performed, then consider opening frx site and reaming under direct vision since it is possible that blind reaming will
result in eccentric reaming and cortical perforation;
- plate fixation:
- providing adequate fracture stability may be all that is necessary to induce fracture stability;
- references:
- Judet decortication and compression plate fixation of long bone non-union: Is bone graft necessary?
- Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
- external fixation:
- references:
- Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus.
- Mechanical and biological treatment of long bone non-unions.