Treatment of aseptic fracture nonunions
10.3760/cma.j.cn121113-20230922-00193
- VernacularTitle:无菌性骨折不愈合的治疗
- Author:
Yejun ZHA
1
;
Xieyuan JIANG
Author Information
1. 首都医科大学附属北京积水潭医院创伤骨科、骨科冲击波诊疗中心，北京 100035
- Keywords:
Fractures, ununited;
Extracorporeal shockwave therapy;
Fracture fixation;
Bone transplantation
- From:
Chinese Journal of Orthopaedics
2024;44(9):644-650
- CountryChina
- Language:Chinese
-
Abstract:
Nonunion of a fracture denotes the scenario wherein the fracture fails to achieve healing within the anticipated timeframe and is improbable to mend without further interventions. This ailment can be classified based on the presence of infection and the biological activity at the fracture site, with a specific emphasis in this discourse on the management of aseptic nonunion. The spectrum of nonunion encompasses atrophic, dystrophic, hypertrophic, pseudarthrosis, and bone defect variants, each necessitating distinctive treatment strategies. Successful management of nonunion hinges upon meticulous diagnosis, efficient infection control, and rectification of any associated deformities, all personalized to the unique circumstances of the individual patient. Soft tissue management plays a pivotal role, often necessitating reparative measures to foster an optimal healing environment. The therapeutic approach to nonunion fractures delineates into non-surgical and surgical modalities, offering advantages in circumventing potential surgical complications. Non-surgical interventions are further subdivided into direct and indirect methods. Indirect interventions encompass lifestyle modifications such as smoking cessation, nutritional optimization, correction of endocrine and metabolic irregularities, and medication adjustments. Direct interventions, conversely, encompass weight-bearing, external fixation, electromagnetic stimulation, ultrasound stimulation, shockwave therapy, and parathyroid hormone administration. Prudent clinical practice dictates the trial of conservative treatments before resorting to surgical interventions, with the latter reserved for instances of treatment resistance or necessitated by aggressive measures. Surgical options encompass a diverse array of techniques, contingent upon soft tissue integrity, degree of bone defect, and comorbidities, including intramedullary nail replacement, dynamic intramedullary nails, plate fixation, circular external fixation frames, and joint replacements. Autogenous bone grafting stands as the gold standard for treating nonunion fractures, while allograft bone grafting and other bone graft substitutes present viable options for addressing nonhealing fractures. The optimal therapeutic approach mandates a comprehensive assessment of the surgeon's expertise, the comparative risks and benefits of interventions, and the patient's individual tolerance.
