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Ortho non union ppt very good

1. Non union

2. Inspection: • Scar, discolouration (due to plaster treatment) sinus( es ) – infection Swelling Deformity (angular/rotational) Shortening Wasting NON UNION

3. Palpation: • Temperature • Tenderness (deep palpation and palpate with nail of your thumb) • Palpable defect (palpate with nail of thumb running from above down) NON UNION

4. Palpation: Abnormal mobility (check in two planes) Crepitus • Loss of transmitted movements (rotate the distal part) • distraction of fragments • Prominence or absence of other bone (fibula) and its status NON UNION

5. Movements : Check for ROM of nearby joints as stiffness due to previous treatment is common. Neurovascular status distally Both iliac crests and legs for bone graft NON UNION

6. Viva questions?? How do you define non-union?

7. when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months.”

8. What are the causes of non-union?

9. How do you classify non-union?

10. JUDET MULLER , WEBER, CECH CLASSIFICATION OF NON UNION a) Hypertrophic- 1.Elephant foot (hypertrophic, rich in callus) 2. Horse foot (mildly hypertrophic, poor in callus) 3. Oligotrophic (not hypertrophic)

11. Elephant foot

12. Horse foot

13. b) Atrophic/ avascular - torsion wedge non union  intermediate fragment has healed at one end and not at the other end - comminuted non union - gap non union - atrophic non union

14. Comminuted non union

15. Gap non union

16. Atrophic non union

17. What is the basis of Weber and Cech classification? - Viability of bone ends determined by strontium85 uptake

18. NON UNION Presence of painless abnormal mobility at the site in two perpendicular planes is deemed pathognomonic of nonunion. Other findings are: • Crepitus • Loss of transmitted movements • Palpable gap or defect in avascular nonunions Patient is unable to bear weight if it is in lower limb.

19. Delayed union Residual pain at fracture site Tenderness on manipulation of the fracture with abnormal mobility usually in one plane. Abnormal mobility if at all present is not gross.

20. What are the common sites of occurrence of nonunions ???

21. Common sites of non union Typical sites include – fracture femoral neck, fracture of scaphoid , fracture neck of talus, fracture lateral condyle humerus

22. XRAY FINDINGS • Marked sclerosis of ends with rounding off appearance. • Medullary canal closed. • Diffuse osteoporosis of both fragments.

23. TREATMENT 1 . BONE MARROW INJECTION 2. Bone grafting -cancellous bonegraft -cortico-cancellous -cortical (fibular graft) 3. Open reduction-Rigid internal fixation 4. Bone transport -Ilizarov’s technique Ultrasound Electrical stimulation .Antibiotics and+ Sx

24. ILIZAROV’S TECHNIQUE- Bone Transport

25. MALUNION

26. MALUNION A malunited fracture is one that has healed with the fragments in a nonanatomic position. It becomes surgically significant only when it impairs function. Malunions generally are caused by either inaccurate reduction or ineffective immobilization during healing. The objective of surgery for malunion is to restore function.

27. Operative treatment of malunion of most fractures should not be considered until 6 to 12 months after the fracture has occurred. In intraarticular fractures, surgery may be required sooner if satisfactory function is to be restored. Eg - Malunion can occur in colles fracture , intertrochanteric #

28. THANK YOU