Traumatic Dens Fracture Patients Comprise Distinct Subpopulations Distinguished by Differences in Age, Sex, Injury Mechanism and Severity, and Outcome
Michael CloneyVineeth ThirunavuAnastasios RoumeliotisPavlos TexakalidisKevin SwongNajib E. El TecleNader S. Dahdaleh
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The skeletal system has a high healing capacity. A nonunion fracture occurs when the natural course of bone healing is impaired. Numerous local and systemic factors participate in the development of a nonunion fracture. Patients with diabetes mellitus (DM), smoking history, obesity, and malnutrition are at risk for nonunion. Moreover, the major local risk factors for impaired bone healing are malalignment, infection, mechanical stability, and tissue loss. In this brief review, we discuss the definition, epidemiology, and diagnosis of nonunion. We further explain the major contributing factors which must be considered in patient selection for nonunion revision surgeries.
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Nonunion is cessation of normal reparative sequence of fracture healing. With an incidence of about 5%to 10%, it is one of the difficult problems in orthopaedics. Definition, classification and location of nonunion are reviewed in this article. Causes of nonunion are analyzed. Traditional and modern treatment methods of nonunion are introduced systemically.
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This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations.We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb.A total of 341,238 patients were eligible for analysis, and 896 patients developed CS (0.3%). In adjusted regression models, older patients had significantly higher odds of CS compared with patients 1 years or younger (odds ratio [OR], 3.29 [95% confidence interval [CI], 1.29-8.37; 2-6 years]; OR, 7.55 [95% CI, 3.08-18.55 [7-12 years]; OR, 10.34 [95% CI, 4.26-25.09 [13-18 years]). Male patients had significantly increased odds of CS compared with female patients, as did patients with lower limb fractures compared with patients without lower limb fractures (OR, 1.93 [95% CI, 1.56-2.40]; OR, 7.61 [95% CI, 6.48-8.94]; respectively). Finally, patients with a firearm injury had higher odds of CS compared with other mechanisms of injury (OR, 3.51 [95% CI, 2.70-4.56]).Older pediatric trauma patients, male patients, and those with lower limb fractures and firearm injuries have increased odds of CS. Information on risk factors can be used to help identify patients most likely to develop CS, facilitating timely diagnosis and treatment.
Pediatric trauma
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Abstract Background : Femoral nonunion is mainly caused by factors such as instability of the fracture end, insufficient blood supply, or infection. However, these factors are mainly related to the different fracture types and inappropriate treatment plans. It is important to analyze the etiology of femoral nonunion and use a simple and effective treatment method to resolve it. The purpose of this study was to divide femoral nonunion into different types and give corresponding treatment strategies. Methods : We retrospectively evaluated 50 patients with femoral nonunion. Patients were divided into six groups and each group was treated with a different strategy. All patients were followed up clinically and radiologically every month until fracture healing. Results : All 50 patients were followed up with an average follow-up time of 17.44 ± 5.48 months. Based on the type of primary femoral fracture and the factors causing nonunion, we divided the femoral nonunion into six types. These included Type I: nonunion caused by instability of simple fracture (AO classification 32-A); Type II: nonunion caused by stress shielding at fracture ends of a simple fracture (AO/OTA classification 32-A); Type III: nonunion in femoral fracture with third fragment (AO/OTA classification 32-B); Type IV: nonunion in femoral fracture with segmental femoral fracture (AO/OTA classification 32-C2); Type V: nonunion in comminuted femoral fracture (AO/OTA classification 32-C3); and Type VI: nonunion caused by infection. Based on these classifications, the following methods are used to treat femoral nonunion. Type I femoral nonunion will achieve fracture healing by blocking screws, exchanging intramedullary nails, or adding plates. Type II femoral nonunion can be addressed through dynamitization or bone graft (possibly in combination with plate fixation) to achieve fracture healing. Type III femoral nonunion requires a treatment plan of bone graft or bone graft combined with plate fixation. The treatment plan for Type IV femoral nonunion is to add a plate, and autogenous bone graft if necessary. Type V femoral nonunion treatment is bone graft combined with plate fixation, or external fixation with subsequent bone segment transport or lengthening. Type VI requires placement of antibiotic bone cement or external fixation added to fix the fracture end. Conclusions : There are several factors associated with failure of femoral fracture treatments by intramedullary nailing. We need to carefully analyze the causes of fracture treatment failure. Our six classifications and corresponding treatment strategies resulted in satisfactory clinical outcomes.
Femoral fracture
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The termination of normal healing for fracture is called for nonunion.Nonunion of long bones is a significant consequence in treating fractures,which is not easy to treat.With an incidence of about 5%～10%,it is one of the difficult problems in orthopaedics.Mechanismes of infected nonunion were introduced in this article,and the causes of infected nonunion were analyzed.Traditional and modern treatment methods of infected nonunion were introduced systemically,especially introduced autoallergic cancellous bone be applied in the treatment of nonunion.
Cancellous bone
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Bone nonunion is a common complication of fracture after operation.It was estimated about 5-10 percent of nonunion and delayed union because of different reasons.There were many different therapeutic methods for bone nonunion with different effect.Minimal invasive surgery developed very quickly and obtained considerable achievements owing to the development of imageology and endoscopic technique and successful practice on surgical field in the past few years.This article will introduce progress of bone nonunion according to literatures for the past few years.
Delayed union
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The term “nonunion” refers to a condition whereby bone fails to heal after fracture. The period that passes between the time of fracture and the determination that a nonunion has developed is highly variable, and may depend on several factors, including which bone is involved, any associated conditions (e.g., open fracture), and the type of treatment. This article provides a concise discussion of the basic science of fracture-healing and nonunion and of the workup and evaluation of nonunion, and a brief overview of the treatment of nonunion.
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Fractures of the humerus account for 5%–8% of all fractures. Nonunion is found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a challenging problem and has to conceive a therapy based on the underlying pathology. The aim of this study was to describe our treatment concepts for this entity and present our results of the last five years. Twenty-six patients were treated for nonunion of the humerus between January 2013 and December 2017. Their charts were reviewed retrospectively and demographic data, pathology, surgical treatment and outcome were assessed. The most frequent location for a nonunion was the humeral shaft, with the most common trauma mechanism being multiple falls. Most often atrophic nonunion (n = 14), followed by hypertrophic and infection-caused nonunion (each n = 4), were found. Our treatment concept could be applied in 19 patients, of which in 90% of those who were available for follow-up consolidation could be achieved. Humeral nonunion is a heterogeneous entity that has to be analyzed precisely and be treated correspondingly. We therefore present a treatment concept based on the underlying pathology.
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Non-union of long bone fractures which was treated with Limb reconstruction system was
followed up and the functional outcome was analysed in this study.Incidence of fracture long bone
increased day by day due to increased RTA leading to increased incidence of nonunion. Controversy
in treatment of nonunion regarding use of devices. Various devices are illizarov ,intramedullary nail,
DCP, LCP, LRS etc. Basic requirements to all biomechanical stability & biological vitality of bones well
provided by external fixator. Among these LRS external fixator simplest & effective devices with
good union rates. LRS is easy to construct frame .LRS is less cumbersome to patients. LRS also have
the facility to distract & compress the fracture & allow dynamization of fracture which are the
essential principles in treatment of nonunion.Bone grafting, docking of fracture sites also can be
done to achieve union. There is still controversy about union rates & complication associated with
LRS in treatment of nonunion. So this study will be conducted to assess the union rate in fracture
nonunion of longbone to assess complications associated with the devices. To evaluate the union
rate with LRS in treatment of nonunion fracture long bones. To assess the duration of treatment
with LRS in fracture nonunion of long bones.Fractures of long bone failed to unite by 6 months.All
types of nonunion long bone. Radiological evidence of nonunion in fractures of longbones. Patient
willing to give written informed consent. Patients who undergo LRS Fixator application for Nonunion
long bones will be analysed for the following factors .Preoperatively the following factors are taken
into consideration ,bone involved, Deformity, Condition of skin, Infection at nonunion site, Range of
motion of adjacent joints, Shortening of the limb. Postoperatively the union is assessed by ,abnormal
mobility at fracture site, Joint Movements, Loosening of LRS pins and Pin track infections.
Radiologically the following factors are seen like ,Gap at fracture site ,Callus formation, Regenerate
in cases of distraction osteogenesis. we selected 30 cases and analysed found that around 80% of
union achieved by Limb reconstruction system.
Long bone
Bone grafting
Delayed union
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Occurance of atrophic nonunion is a complex process. Previous studies suggested that atrophic nonunion was mainly due to lack of blood supply of fracture fragments, but recent studies found that blood supply was not deficiency in middle and late stages, indicating that decreased osteogenic factors and blood supply in early stages might play an important role in morbidity. Current effective treatment measures for atrophic nonunion mainly include bone graft and fixation,physical therapy, local injection therapy. All-round preventive could reduce incidence of atrophic nonunion. Atrophic nonunion is still a troublesome complication of fractures in orthopaedics, and more attention should be paid for its effective prevention and treatment. The paper summarized recent original articles about atrophic nonunion and reviewed the occurrence mechanisms, diagnosis, prevention and treatment measures of this disease.
Blood supply
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