What are the complications that could come along with non-union exactly? And how do we avoid non-union ?
They say non-union is caused by the bones not being able to heal well, Like healing at an abnormal rate, or if we lengthen too slowly or quickly..
So if we know the causes, what are the effects ? And how do we avoid non-union in the first place?
Non union means the gap between both parts of the bone doesn't feel up which can lead to a bone graft (a serious procedure) and if that fails, to amputation
Nonunion is permanent failure of healing following a broken bone.
Nonunion is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is interrupted or stalled. In some cases a pseudo-joint (pseudarthrosis) develops between the two fragments with cartilage formation and a joint cavity. More commonly the tissue between the ununited fragments is scar tissue.
Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in very few cases. In general, if a nonunion is still evident at 6 months post injury it will remain unhealed without specific treatment, usually orthopedic surgery. A non-union which does go on to heal is called a delayed union.
Surgical treatment includes removal of all scar tissue from between the fracture fragments, immobilization of the fracture with metal plates, rods and or pins and bone graft. In simple cases healing may be evident within 3 months. Gavriil Ilizarov revolutionized the treatment of recalcitrant nonunions demonstrating that the affected area of the bone could be removed, the fresh ends "docked" and the remaining bone lengthened using an external fixator device. The time course of healing after such treatment is longer than normal bone healing. Usually there are signs of union within 3 months, but the treatment may continue for many months beyond that.
By definition, a nonunion will not heal if left alone. Therefore the patient's symptoms will not be improved and the function of the limb will remain impaired. It will be painful to bear weight on it and it may be deformed or unstable. The prognosis of nonunion if treated depends on many factors including the age and general health of the patient, the time since the original injury, the number of previous surgeries, smoking history, the patient's ability to cooperate with the treatment. In the region of 80% of nonunions heal after the first operation. The success rate with subsequent surgeries is less.
Nonunions happen when the bone lacks adequate stability, blood flow, or both. They also are more likely if the bone breaks from a high-energy injury, such as from a car wreck, because severe injuries often impair blood supply to the broken bone.
Several factors increase the risk of nonunion.
- Use of tobacco or nicotine in any form (smoking, chewing tobacco, and use of nicotine gum or patches) inhibits bone healing and increase the chance of a nonunion
- Older age
- Severe anemia
- Diabetes
- A low vitamin D level
- Hypothyroidism
- Poor nutrition
- Medications including anti-inflammatory drugs such as aspirin, ibuprofen, and prednisone. The physician and patient should always discuss the risks and benefits of using these medications during fracture healing
- Infection
- A complicated break that is open or compound
Non-unions are more likely to happen if the injured bone has a limited blood supply.
- Some bones, such as toe bones, have inherent stability and excellent blood supply. They can be expected to heal with minimal treatment.
- Some bones, such as the upper thighbone (femoral head and neck) and small wrist bone (scaphoid), have a limited blood supply. The blood supply can be destroyed when these bones are broken.
- Some bones, such as the shinbone (tibia), have a moderate blood supply, however, an injury can disrupt it. For example, a high-energy injury can damage the skin and muscle over the bone and destroy the external blood supply. In addition, the injury can destroy the internal blood supply found in the marrow at the center of the bone.
Treatment
Nonsurgical and surgical treatments for nonunions have advantages and disadvantages. More than one alternative may be appropriate. Discuss with your doctor the unique benefits and risks of treating your nonunion. Your doctor will recommend the treatment option that is right for you.
A) Nonsurgical Treatment
An external bone stimulator is applied to the skin overlying the nonunion. Some nonunions can be treated nonsurgically. The most common nonsurgical treatment is a bone stimulator. This small device delivers ultrasonic or pulsed electromagnetic waves that stimulate healing The patient places the stimulator on the skin over the nonunion from 20 minutes to several hours daily. This treatment must be used every day to be effective.
B) Surgical Treatment
Surgery is needed when nonsurgical methods fail. You may also need a second surgery if the first surgery failed. Surgical options include bone graft or bone graft substitute, internal fixation, and/or external fixation.
Avoid it by not electing to break a healthy bone and undergoing the surgery. Lessen the risk by having a doctor who is experienced in clean osteotomies, not smoking, being young, being in good physical condition, avoiding anti-inflammatory painkillers, having good nutrition, supplementing vitamin D, lengthening at a reasonable rate, lengthening a reasonable amount and undergoing physical therapy to encourage blood flow.
Quote from: 682 on March 28, 2017, 04:47:20 PMNonunion is permanent failure of healing following a broken bone.
Nonunion is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is interrupted or stalled. In some cases a pseudo-joint (pseudarthrosis) develops between the two fragments with cartilage formation and a joint cavity. More commonly the tissue between the ununited fragments is scar tissue.
Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in very few cases. In general, if a nonunion is still evident at 6 months post injury it will remain unhealed without specific treatment, usually orthopedic surgery. A non-union which does go on to heal is called a delayed union.
Surgical treatment includes removal of all scar tissue from between the fracture fragments, immobilization of the fracture with metal plates, rods and or pins and bone graft. In simple cases healing may be evident within 3 months. Gavriil Ilizarov revolutionized the treatment of recalcitrant nonunions demonstrating that the affected area of the bone could be removed, the fresh ends "docked" and the remaining bone lengthened using an external fixator device. The time course of healing after such treatment is longer than normal bone healing. Usually there are signs of union within 3 months, but the treatment may continue for many months beyond that.
By definition, a nonunion will not heal if left alone. Therefore the patient's symptoms will not be improved and the function of the limb will remain impaired. It will be painful to bear weight on it and it may be deformed or unstable. The prognosis of nonunion if treated depends on many factors including the age and general health of the patient, the time since the original injury, the number of previous surgeries, smoking history, the patient's ability to cooperate with the treatment. In the region of 80% of nonunions heal after the first operation. The success rate with subsequent surgeries is less.
Nonunions happen when the bone lacks adequate stability, blood flow, or both. They also are more likely if the bone breaks from a high-energy injury, such as from a car wreck, because severe injuries often impair blood supply to the broken bone.
Several factors increase the risk of nonunion.
- Use of tobacco or nicotine in any form (smoking, chewing tobacco, and use of nicotine gum or patches) inhibits bone healing and increase the chance of a nonunion
- Older age
- Severe anemia
- Diabetes
- A low vitamin D level
- Hypothyroidism
- Poor nutrition
- Medications including anti-inflammatory drugs such as aspirin, ibuprofen, and prednisone. The physician and patient should always discuss the risks and benefits of using these medications during fracture healing
- Infection
- A complicated break that is open or compound
Non-unions are more likely to happen if the injured bone has a limited blood supply.
- Some bones, such as toe bones, have inherent stability and excellent blood supply. They can be expected to heal with minimal treatment.
- Some bones, such as the upper thighbone (femoral head and neck) and small wrist bone (scaphoid), have a limited blood supply. The blood supply can be destroyed when these bones are broken.
- Some bones, such as the shinbone (tibia), have a moderate blood supply, however, an injury can disrupt it. For example, a high-energy injury can damage the skin and muscle over the bone and destroy the external blood supply. In addition, the injury can destroy the internal blood supply found in the marrow at the center of the bone.
Treatment
Nonsurgical and surgical treatments for nonunions have advantages and disadvantages. More than one alternative may be appropriate. Discuss with your doctor the unique benefits and risks of treating your nonunion. Your doctor will recommend the treatment option that is right for you.
A) Nonsurgical Treatment
An external bone stimulator is applied to the skin overlying the nonunion. Some nonunions can be treated nonsurgically. The most common nonsurgical treatment is a bone stimulator. This small device delivers ultrasonic or pulsed electromagnetic waves that stimulate healing The patient places the stimulator on the skin over the nonunion from 20 minutes to several hours daily. This treatment must be used every day to be effective.
B) Surgical Treatment
Surgery is needed when nonsurgical methods fail. You may also need a second surgery if the first surgery failed. Surgical options include bone graft or bone graft substitute, internal fixation, and/or external fixation.
Avoid it by not electing to break a healthy bone and undergoing the surgery. Lessen the risk by having a doctor who is experienced in clean osteotomies, not smoking, being young, being in good physical condition, avoiding anti-inflammatory painkillers, having good nutrition, supplementing vitamin D, lengthening at a reasonable rate, lengthening a reasonable amount and undergoing physical therapy to encourage blood flow.
What about a smoker going to do the surgery?
Paley said stop one month before the surgery what do you think guys?
You should just stop smoking all together and hopefully LL may be the impetus for you to quit for good.
Thank you so very much 
This really put me at ease
I don't smoke, I am wayy too young.
I exercise and hit the gym 3 times a week, jog on the other 4.
And I maintain a healthy diet because of my gym program.
Thanks again It means a lot to me. I really feel less nervous now.
I don't smoke in the first place..
I dislike it very much thankfully.
Thanks for your response though
Smoking is a downfall for this surgery.
Ruins the chances of having a safe one.
A month would be a good option since during the surgery process, Withdrawal symptoms may kick in because obviously Nicotine is highly addictive. It produces artificial levels of Dopamine in your brain. Leading to Tolerance and Addiction.
If you were to stop for around 2 months or more before surgery, You are more tempted to smoke during the surgery.
The less months you cut down, The slightly more tolerable it becomes to not smoke during surgery.
Obviously this isn't much of a difference, But it Is a difference.
But try to cut down on smoking for good.
Quote from: James24 on March 29, 2017, 09:07:02 AMSmoking is a downfall for this surgery.
Ruins the chances of having a safe one.
A month would be a good option since during the surgery process, Withdrawal symptoms may kick in because obviously Nicotine is highly addictive. It produces artificial levels of Dopamine in your brain. Leading to Tolerance and Addiction.
If you were to stop for around 2 months or more before surgery, You are more tempted to smoke during the surgery.
The less months you cut down, The slightly more tolerable it becomes to not smoke during surgery.
Obviously this isn't much of a difference, But it Is a difference.
But try to cut down on smoking for good.
I don't think one month is enough, as i said Paley recommended 1 month, Guichet several months and some doctors recommended 3 months. Maybe 5 months is a safe time i don't know.
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