TY - JOUR

T1 - Nonunion - consensus from the 4th annual meeting of the danish orthopaedic trauma society

AU - Schmal, Hagen

AU - Brix, Michael

AU - Bue, Mats

AU - Ekman, Anna

AU - Ferreira, Nando

AU - Gottlieb, Hans

AU - Kold, Søren

AU - Taylor, Andrew

AU - Tengberg, Peter Toft

AU - Ban, Ilija

AU - Danish Orthopaedic Trauma Society

PY - 2020

Y1 - 2020

N2 - Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as 'mechanobiology' or the 'diamond concept' determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding abso-lute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteo- conductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction.

AB - Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as 'mechanobiology' or the 'diamond concept' determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding abso-lute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteo- conductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction.

KW - Educative

KW - Fracture treatment

KW - Nonunion

KW - Principals

KW - Review

KW - Strain theory

U2 - 10.1302/2058-5241.5.190037

DO - 10.1302/2058-5241.5.190037

M3 - Journal article

C2 - 32071773

AN - SCOPUS:85079517799

VL - 5

SP - 46

EP - 57

JO - EFORT Open Reviews

JF - EFORT Open Reviews

SN - 2396-7544

IS - 1

ER -