Internal Fixation of Nonunions
- 1 February 2004
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health)
- Vol. 419 (419), 13-20
- https://doi.org/10.1097/00003086-200402000-00004
Abstract
We review the two major types of internal fixation of nonunions (plating and intramedullary nailing), and analyze nonunions in different locations (upper and lower extremities). Depending on the type and the location of the nonunion, plating or intramedullary nailing may be selected. Both have advantages and disadvantages: plating requires opening the nonunion site, which entails some damage to the soft tissues, and carries with it a risk of secondary infection. With plating, it often is impossible to do a real decortication because the periosteum may be thin and poorly adherent to bone, and the quality of bone may prove insufficient to achieve good fixation with most of the screws. However, plating still is used in metaphyseal nonunions, and angular deformities may be corrected by applying a plate under tension on the convex side of the bone. Nailing can be done percutaneously in numerous cases; it has a smaller risk of infection but, should an infection be present, there is a risk that it may spread over the entire length of the medullary cavity. Nailing stimulates bone formation, but noninterlocking nails may cause shortening and rotational instability of the nonunion site. Plate fixation was popular approximately 20 years ago, but now has been largely superseded by intramedullary nailing except for proximal or distal nonunions. Dynamic locking nails are preferable. Successful treatment of nonunions often requires several consecutive surgical actions and a global strategy must be established from the beginning, taking care not to interfere with the successive steps.Keywords
This publication has 17 references indexed in Scilit:
- OPEN REDUCTION AND INTERNAL FIXATION OF DELAYED UNIONS AND NONUNIONS OF FRACTURES OF THE DISTAL PART OF THE HUMERUSThe Journal of Bone and Joint Surgery-American Volume, 2003
- HUMERAL NONUNION ASSOCIATED WITH METALLOSIS SECONDARY TO USE OF A TITANIUM FLEXIBLE HUMERAL INTRAMEDULLARY NAILThe Journal of Bone and Joint Surgery-American Volume, 2002
- IN SITU FIXATION OF PELVIC NONUNIONS FOLLOWING PATHOLOGIC AND INSUFFICIENCY FRACTURESThe Journal of Bone and Joint Surgery-American Volume, 2002
- Nonunion of a Hoffa Fracture in a ChildJournal of Orthopaedic Trauma, 2000
- The use of interlocked ‘customised’ blade plates in the treatment of metaphyseal fractures in patients with poor bone stockInjury, 2000
- Treatment of Humeral Shaft Delayed Unions and Nonunions with Humeral Locked NailsJournal Of Trauma-Injury Infection and Critical Care, 2000
- MANAGEMENT OF SURGICAL NECK NONUNIONSOrthopedic Clinics of North America, 2000
- NONUNION OF TIBIAL SHAFT FRACTURES TREATED WITH LOCKED INTRAMEDULLARY NAILING WITHOUT BONE GRAFTINGJournal Of Trauma-Injury Infection and Critical Care, 1993
- Reaming versus non-reaming in medullary nailing: Interference with cortical circulation of the canine tibiaArchives of orthopaedic and trauma surgery, 1990
- Experiences with Lengthening of the Femur over an Intramedullary RodThe Journal of Bone & Joint Surgery, 1956