Non-union risk

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Hey folks,

I read a lot of papers yesterday related to non-union in fractures. It occurs in almost 20 percent from what I hear. And out of them, many heal without surgery. Some heal with surgery after a pretty long time. And some do not heal at all. Even though osteotomy is done carefully in LL, but still that risk is there that can lead to permanent disability. Please weight in that before you take the plunge. If anyone has counter arguments to this, I am all ears.

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Great article : https://www.ncbi.nlm.nih.gov/books/NBK554385/

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Quote from: boklecrt on August 06, 2022, 12:16:29 PMi dont think you should stress about non union in current year all that much, if at all

risks for non union:

1. betzbone - mechanical nail that cannot be reversed if you do get non union, would require additional surgery and changing of the nail i.e. could turn out quite costly(unicorn case with guichet nail is the most famous example of a non union disaster, 60k initial surgery followed by 100k more in complications)
2. user hasaki here was left with non union by livelifetaller which is absolutely mind boggling how it could have been allowed as multiple xrays had been done over months and noone saw the non union

if you do external/lon and get non union you just reverse the frame back and address the non union by re-damaging the both ends in order to create a blood clot which would turn into callus and then assess why it happened in the first place. speed of lengthening is the main culprit, next to age, smoking, alcohol, lack of sleep etc

also obviously with precice nails non union can be addressed the same way


embolism and trombosis are the big ones to worry about with femur surgeries, and to a lesser extent with tibia

The reason I do not worry about embolism and thrombosis is I will be dead and not be limping for the rest of my life..I prefer being dead over being disabled if you understand what i am saying..

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Quote from: boklecrt on August 07, 2022, 02:10:49 AMyou have an interesting thought process

given these two choices - death or limping, i personally would choose limping

why do you think non union automatically means "life long limping"

non union is not a difficult complication to heal - if caught on time. if you get Xrays every 2-3 weeks it can be caught quite early and treated immediately

risk factors for non union:
1. extending too fast - lifelivetaller's 1.5mm-2mm a day extending protocols as an example
2. extending too early after osteotomy - minimum 7-10 days for the blood clot from the first surgery to become a rubbery bloodless callus that can be pulled apart like a bubble gum
3. doctor using only a hammer without a chisel and completely shattering the bones in the osteotomy leading to a bunch of small fragments instead of one clean break
4. lack of sleep due to stress and discomfort and pain
5. not enough calories due to lack of appetite
6. not enough protein that builds the callus
7. not enough calcium that builds the callus
8. drinking alcohol - vasoconstrictor
9. smoking cigarettes - impairs healing
10. age - older you are the slower you heal
11. having underlying chronic diseases - aids, autoimmune stuff, diabetes, etc - 99% of doctors wont operate on you if any of these are present

Thanks man for the info..How old is too old in your opinion? Under 40 is still alright I think? Dr Donghoon Lee has never had even 1 non-union..So osteotomy process plays a role as well I guess.

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Quote from: LL2022 on August 08, 2022, 07:07:14 PMI am one of those unlucky cases that have a much slower callus formation, I believe we could call it a delayed union. I was told to first slow down from 1mm/day to 0,75mm for two weeks, now I have been instructed to do 0,5mm for another 2weeks after my X-ray showing barely any improvement. At this point I think the culprit is simply just genetics, stress/anxiety and possibly lack of deep/REM sleep since I wake up every other hour.

I am in my early twenties, have never smoked and overall healthy.

Stay strong man..Still early days..Wish you a speedy recovery..  Who is your doc? Is he confident of treating this complication?

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Quote from: LL2022 on August 17, 2022, 09:38:34 PMMy doctor is Dr Mustafa Uysal, he is competent and assured me it isn’t non union since my xrays show some callus albeit not very much. I have reached 4.5cm and have my next xray in 2 days. Fingers crossed there is some improvement, I really don’t wanna reverse lengthen lol…

Awesome!