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t/t of delayed or non union
#fracture #fracturecomplications #orthopedics

Most fractures in delayed union unite on continuing the conservative treatment. Sometimes, this may not occur and the fracture may need surgical intervention. Bone grafting with or without internal fixation may be required. Treatment of non-union depends upon the site of non-union and the disability caused by it. The following possibilities of treatment should be considered, depending upon the individual cases.

Open reduction, internal fixation and bone grafting: This is the commonest operation performed for non-union. The grafts are taken from iliac crest. Internal fixation is required in most cases.

Excision of fragments: Sometimes, achieving union is difficult and time consuming compared to excision of one of the fragments. This can only be done where excision of the fragment will not cause any loss of functions. An excision may or may not need to be combined with replacement with an artificial mould (prosthesis). For example, the lower-end of the ulna can be excised for non-union of the fracture of the distal-end of the ulna without much loss. In non-union of fracture of the neck of femur in an elderly, the head of the femur can be replaced by a prosthesis (replacement arthroplasty)

. • No treatment: Some non-unions do not give rise to any symptoms, and hence require no treatment, e.g., some non-unions of the fracture scaphoid.

• Ilizarov’s method: Prof. Ilizarov from the former USSR designed a special external fixation apparatus for treating non-union

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owner: nerdparty67 - (no access) - Maheshwari Ortho-1.pdf, p66


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