Nonunion is the abnormal movement of a bone that has not healed properly. It can be caused by trauma, surgery, or growth abnormalities. Symptoms include pain and abnormal movement. Treatment options include internal fixation, external fixation, and bone grafting.
Nonunion is the abnormal movement of a bone that has been fractured and has not healed properly. The term “pseudarthrosis” comes from the Greek words pseudo, which means “false”, and osteoarthritis, which means “joint”. It is often referred to as pseudarthrosis or simply a false joint.
Most nonunions result from improper healing after trauma or fusion surgery. It can also occur due to a growth abnormality, usually during the first 18 months of life. This is known as congenital pseudarthrosis and can occur in any bone, but most commonly occurs in the tibia, the smaller of the two bones in the lower leg. It is also common in the radius, one of the wrist bones.
There is usually pain involved in nonunion, the result of the two pieces of bone rubbing together. There may also be no pain, usually in the case of a slight fracture or post-surgery, and is only found when a scan is done, either specialized X-rays or a computed tomography (CT) scan. These are often done after fusion surgery to make sure there has been proper healing if there are no obvious abnormal movements.
There are several causes of improper healing that cause pseudarthrosis. These are mostly seen after surgery to repair an already damaged area. They can be the result of loosening of the hardware used in the fusion, infection, or simply poor wound healing. Smoking, diabetes and/or heart disease can be problems that cause health problems and even lead to nonunion. In the event of a fracture, pseudarthrosis is usually caused by poor healing ability. In congenital pseudarthrosis, there is an underlying disease factor that is causing the problem.
Nonunion is treated in several ways: internal fixation, external fixation, and bone grafting. Often, it’s a combination of the three. In the case of congenital pseudarthrosis, the underlying disease is also addressed if possible.
Internal fixation is the use of screws, plates, or rods to hold bone together. This is often combined with bone grafting to help the bone heal faster and more efficiently. Bone grafting involves taking bone from another place, usually the hip, and placing it in the fracture. If there is an infection, which is commonly a problem, it needs to be eliminated first.
External fixation uses an external apparatus to hold the bone together and compress it. The most commonly used apparatus is the one developed by an orthopedic surgeon, Gavril Abramavo Ilizarov, which is simply called the Ilizarov apparatus. It can be used in conjunction with bone grafting and internal fixation, but is preferably used alone, because the other two methods have a risk of infection or the fracture is simply too severe to operate internally.
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