By Redento Mora, Luisella Pedrotti, Gabriella Tuvo (auth.), Redento Mora (eds.)
In 2%-7% of all bone fractures, union is behind schedule or fails. Nonunions of the bones signify a problem for orthopedic surgeons and will have a critical mental impression on those sufferers. additionally, the social rate of handling those lesions, usually requiring a number of systems, can be quite excessive, and issues on the topic of wrong therapy usually are not infrequent. this article relies at the improvement over decades of the units and operative ideas of monofocal, bifocal, and multifocal compression-distraction osteosynthesis, in cooperation with the CITO Institute of Moscow and the LNIITO Institute of Riga, and on hundreds and hundreds of operative tactics on noninfected and contaminated nonunions for my part played by means of the authors either within the former Soviet Union, Russia and Italy. the first goal of this publication is to debate at the moment to be had instruments for diagnosing lengthy bone nonunions, to demonstrate the technique of prevention, and to specify the indicators for administration utilizing compression-distraction techniques.
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Extra resources for Nonunion of the Long Bones: Diagnosis and treatment with compression-distraction techniques
The main clinical signs are tenderness and presence of micromotion. Radiographic signs include: persistent fracture line, bone end sclerosis, hypertrophic callus formation or atrophic bone resorption, and possibly radiolucency around osteosynthetic devices. Pseudoarthrosis (or synovial pseudoarthrosis) is defined as a fracture that has failed to heal and in which a cleft is observed between the bone ends. This cavity is fluid-filled and lined by a membrane. Radiographic examination very often shows a typical “mortar and pestle” bone configuration.
2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Markel MD, Chao EY (1993) Noninvasive monitoring techniques for quantitative description of callus mineral content and mechanical properties. Clin Orthop Relat Res 293:37–45 Massare C, Evrard J (1976) Critères de consolidation des fractures des os longs de l’adulte. Rev Chir Orthop 62[Suppl. 2]:177–186 Abendschein W, Hyatt GW (1970) Ultrasonics and selected physical properties of bone. Clin Orthop Relat Res 69:294–301 Gerlanc M, Haddad D, Hyatt GW et al (1975) Ultrasonic study of normal and fractured bone.
Mod Pathol 11:427–431 Simpson AH, Wood MK, Athanasou NA (2002) Histological assessment of the presence or absence of infection in fracture non-union. Injury 33:151–155 Perry GR, Pearson RL, Miller GA (1991) Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis. J Bone Joint Surg Am 73:745–749 Gustilo R (1989) Orthopaedic infection. Saunders, Philadelphia 18. 19. 20. 21. 22. Section IV NONUNIONS: TREATMENT Prevention REDENTO MORA, LUISELLA PEDROTTI, GIOVANNI BATTISTA GALLI, STEFANO GILI, ANNA MACCABRUNI Introduction Prevention of nonunions is based on complete understanding of both biological and mechanical aspects of bone callus formation; it requires a good control of fracture treatment technique, which has to be most accurate from the start following the classic rules of reduction and immobilization .