Non-Union of Fractures – Comprehensive MBBS Final Year Presentation.pptx

Non union of fractures

1. Non-Union of Fractures Dr.R.Raja Jawaharlal Asst Professor, Department of Orthopaedics

2. Objectives Define non-union and differentiate from delayed/malunion Explain classification and pathophysiology Recognize clinical & radiological features Outline management and prevention strategies

3. Definition Failure of fracture to unite within expected time (≥ 6–9 months) No progressive healing on serial radiographs

4. Delayed Union vs Non-Union vs Malunion Delayed Union: slow healing but progressing Non-Union: arrest of healing Malunion: fracture heals in abnormal position

5. Clinical Importance Persistent pain & disability Risk of deformity and pseudoarthrosis Socioeconomic burden

6. Epidemiology 5–10% of all fractures may result in non-union More common in tibia, humerus, scaphoid Higher risk in open fractures

7. Classification Overview

8. Hypertrophic Non-Union Abundant callus (Elephant foot) Adequate biology but poor stability Managed with rigid fixation

9. Oligotrophic Non-Union Minimal callus Suggests instability + impaired biology

10. Atrophic Non-Union No callus formation Poor vascularity or bone loss Needs bone grafts or biologics

11. Normal Fracture Healing Inflammation → Soft callus → Hard callus → Remodeling

12. Biological Causes of Failure Poor blood supply Infection Soft tissue interposition

13. Mechanical Causes of Failure Inadequate fixation Excessive motion at fracture site

14. Infection in Non-Union Osteomyelitis interferes with union Seen in open fractures, contaminated wounds

15. Blood Supply & Non-Union Vascularity crucial for callus formation AVN-prone sites: scaphoid, femoral neck

16. Patient-Related Risk Factors Smoking, diabetes, malnutrition Corticosteroid use, osteoporosis

17. Fracture-Related Risk Factors Severe comminution Bone loss Soft tissue injury

18. Treatment-Related Risk Factors Poor surgical technique Inadequate fixation/immobilization Improper implant choice

19. Clinical Symptoms Pain at fracture site Loss of function

20. Clinical Signs Tenderness Abnormal mobility Deformity

21. X-ray Features Persistent fracture line Sclerosis of bone ends Absence of callus

22. CT Scan Defines fracture gap Evaluates implant position

23. MRI in Non-Union Assesses vascularity Detects osteonecrosis

24. General Principles of Management Biology + Stability = Union Eliminate infection, enhance blood supply

25. Hypertrophic Non-Union Management Rigid fixation (plating, IM nailing) Compression at fracture site

26. Atrophic Non-Union Management Debridement of necrotic tissue Bone grafting / BMPs Stable fixation

27. Oligotrophic Non-Union Management Improve stability Enhance biology

28. Internal Fixation Plates, nails, locking compression plates

29. External Fixation Ilizarov frame Taylor Spatial Frame

30. Bone Grafting Autograft: gold standard (iliac crest) Allograft for large defects Synthetic substitutes

31. Biological Enhancements BMPs, PRP, Stem cells

32. Masquelet Technique Stage 1: Cement spacer induces membrane Stage 2: Bone graft inside membrane

33. Low-Intensity Pulsed Ultrasound (LIPUS) Stimulates callus formation Mixed evidence

34. Electromagnetic Stimulation Pulsed electromagnetic fields (PEMF) Used for delayed union/non-union

35. Shockwave Therapy Focused shockwaves promote healing Emerging therapy