All tissues in the body require blood supply to remain alive and heal. Severely damaged bone also has a damaged blood supply. This leads to bone healing slowly delayed union or never healing nonunion. Below is an example of a fracture that never healed properly nonunion fracture. The first picture is the patient's nonunion fracture.
The second picture shows the healed arm. Infection When a bone or fracture is infected, it is called osteomyelitis. An infection makes it difficult or impossible for the fractured bone to heal because the infection impairs bone development and may damage the blood supply.
Infection kills the bone and the blood supply to the bone making healing nearly impossible. The refixation will include insertion of poller screws screws in different planes , reaming the canal and fixation with a rod. Throughout the procedure we use intraoperative X-ray to monitor the progress and position of the metalwork inserted.
Depending on the type of fixation achieved you will be advised whether you can weight bear or not post operatively. If the tissue samples taken during the surgery show any sign of infection usually takes days for the lab to process the samples you will be advised which antibiotics to take. The duration of antibiotic treatment post surgery is usually around 6 weeks. Atrophic non-union fractures occur when the bone ends have a very limited or nonexistent blood supply or parts of the bone are missing.
There is almost certainly infection present. X-ray and CT scans will usually show significant instability of the metalwork with bone defects. In patients with atrophic non-union fractures, we have to be aggressive in treatment otherwise the condition can get worse and it can become more difficult to treat.
As part of your hospital visit, you will undergo the following in order to diagnose a non-union fracture:. The X-ray in particular is useful in helping us to diagnose a non-union fracture. We will be analysing the x-ray to look for any signs of union, bone instability, broken metalwork and lucency around the metalwork. Treatment may involve surgery to remove the infection, to better stabilize the fracture, or to stimulate bone growth with bone graft.
The main treatment is re-fixation of the non-union fracture. This can be done either by using the method of fixation as before, although most surgeons agree that it is worth considering changing the method of fixation. For the fixation method, any surgical fixation technique can be used intramedullary nail, plate and screws, fine wire frames TSF, Ilizarov.
During your consultation with Mr Matija Krkovic, you will be explained in detail what the surgery will involve and which method in particular has been chosen to treat your nonunion fracture.
Each person's recovery period will vary, based on how well their body can heal. Once infection is cleared, other morbidities or concerns impeding healing and restoration for malunion or nonunion may be addressed. Penn surgeons also use antibiotic-laced bone cement during subsequent fracture reconstruction as an additional measure to prevent the infection from returning. Inadequate blood flow , if present, is a cause of bone tissue breakdown and bone death osteonecrosis.
When inadequate blood supply to the bone is suspected, a CT or SPECT scan can be initiated to determine the presence of dead bone, but is not always reliable.
Treatment of osteonecrosis at the Center typically involves excoriation to remove dead bone at the nonunion, followed by microsurgery an integral skillset for surgeons at the Center , vascularized or nonvascularized bone grafts and osteogenic or revascularization interventions to restore living bone and blood flow to the site of injury.
If the amount of affected bone removed results in a disproportion in length, advanced limb lengthening procedures are put in place.
The Limb Lengthening Program at Penn has highly-skilled specialists who can correct and improve limb length inequalities using an advanced, modern technique offered at only a few centers in the country. Compared to traditional limb lengthening technology which required a large external fixation framework around the affected limb including several pins that penetrate the tissue on either side of the defect, this novel process is much easier for the patient and carries much lower risk for infection.
While it may not be amenable to all patients, when possible, advanced options are utilized. A magnetic lengthening rod is then inserted into the bone ends. The lengthening rod houses a tiny geared mechanism controlled by an external magnet.
The amount of time for the lengthening depends on the amount of distance needed. As the bones lengthen over time, muscle, tendon, skin, and arteries also respond and grow. Biomechanical failure can be caused by any of a number of incidents that prime the fracture for instability and consequent hardware failure, resulting in malunion and nonunion.
A blueprint for fixation and follow-up care is then created and put into action. Depending upon the mechanical circumstances at the fracture, surgical fixation proceeds.
A traditional rigid construct can be used as well as an innovative dynamic flexible implant.
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