Analysis of causes and treatment modality in non-union of long bones diaphyseal fractures

ABSTRACT

The purpose of this study was to analyze the causes of nonunion leading to modification in treatment modalities in long bones diaphyseal fractures. Descriptive Study. Combined Military Hospital Quetta, Combined Military Hospital Sialkot, Pakistan, from 5th Sep 2005 to 26th Dec 2008. Non-healing long bones diaphyseal fractures > 6 months were included with exclusion of pathological fractures, delayed union < 6 months. Patients general profile and fracture details with non-union causes were recorded. Old failed surgery with re-do surgical intervention was analyzed. Infected cases were treated with removal of implant, thorough debridment, appropriate antibiotics followed by delayed stabilization while non-infected cases with stable fixation and bone grafting. Out of fifty six patients, tibial fractures were maximum 17[30.4%], femur 16[28.6%], radius ulna 15[26.6%], and humerus 8[14.3%]. Most patients were young 37[66.07%] and male 48[85.7%]. Road traffic accident caused 43[76.8%] fractures. Causes of non-union were high energy trauma 37[66%], insufficient stabilization 31[55.4%], followed by smoking, soft tissue interposition, poor nutrition, NSAIDs, broken implants, infection, intact fellow bone, multiple segment fracture, repeated manipulation, chronic illness and neurovascular impairment in descending order. Plates failed more than K nails. Complications like superficial and deep infection, neuroprexia and delayed healing settled with bone healing in mean time 4.76 months. Nonunion of long bones diaphyseal fractures can be prevented by avoiding causative agents, early intervention, tissue protection and stable fixation. Interlock nailing is best for femur, good for tibia, may be useful in humerus but not suitable for radius and ulna. Bone graft accelerates healing process. Early re do surgery must be considered because of manageable rate of complications