J Korean Fract Soc.  2017 Jan;30(1):40-51. 10.12671/jkfs.2017.30.1.40.

Impaired Bone Healing Metabolic and Mechanical Causes

• Park SG
• Shon OJ

• KMID: 2367352
• DOI: http://doi.org/10.12671/jkfs.2017.30.1.40

Abstract

Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.

Keyword

Nonunion; Metabolic; Mechanical

MeSH Terms

Alcoholism
Comorbidity
Fracture Fixation
Fractures, Multiple
Methods
Osteonecrosis
Osteoporotic Fractures
Risk Factors
Smoke
Smoking
Soft Tissue Injuries
Smoke

Figure

• 

  Fig. 1 (A) Small push and pull movement of the plate can make the non-locked screw loose with marked bone resorption around screw head. (B) The locked screw does not tilt around the axis, consequently the same movement of the plate does not loosen the the screw as much as the non-locked screw. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

• 

  Fig. 2 The regeneration tissue in the widened gap tolerates the deformation while that in the small gap disrupts the deformation because the strain is about 100% larger. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

• 

  Fig. 3 (A) The displacement in a simple fracture widens the fracture gap as the same amount. (B) A multi-fragmentary fracture displaced the same amount as the simple fracture. Instead of a simple fracture, multiple gaps share the overall displacement, and the resultant strain is smaller than that of simple fracture.

• 

  Fig. 4 The divergent locked screws showing better anchorage after application of pull-out load than parallel screws.

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  Fig. 5 When the same bending moment is applied, a long plate produces much less pull-out force than a short plate. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

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