Nonunion

Nonunion
"Nonunion" also means a workforce that does not belong to a trade union.

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 a 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.

Contents

Clinical features

A history of a broken bone is usually apparent. The patient complains of persistent pain at the fracture site and may also notice abnormal movement or clicking at the level of the fracture. An x-ray plate of the fractured bone shows a persistent radiolucent line at the fracture. Callus formation may be evident but callus does not bridge across the fracture. If there is doubt about the interpretation of the Xray, stress Xrays, tomograms or CT scan may be used to make sure.

Pathophysiology

Hypertrophic non-union

Callus is formed, but the bone fractures have not joined. This can be due to inadequate fixation of the fracture, and treated with rigid immobilisation.

Atrophic non-union

No callus is formed. This is often due to impaired bony healing, for example due to vascular causes (e.g. impaired blood supply to the bone fragments) or metabolic causes (e.g. diabetes or smoking). Failure of initial union, for example when bone fragments are separated by soft tissue may also lead to atrophic non-union. Atrophic non-union can be treated by improving fixation, removing the end layer of bone to provide raw ends for healing, and the use of bone grafts.

Untreated prognosis

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.

Treatment

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. 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.

Treated prognosis

This 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.

See also

External links


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Look at other dictionaries:

  • Nonunion — Non*un ion, a. 1. Not belonging to, or affiliated with, a trades union; as, a nonunion carpenter. [Webster 1913 Suppl.] 2. Not employing trade union members; not recognizing or favoring trades unions or trades unionists; as, a nonunion… …   The Collaborative International Dictionary of English

  • nonunion — non·union /ˌnän yü nyən/ adj 1: not belonging to or connected with a labor union nonunion carpenters 2: not recognizing or favoring labor unions or their members 3: not produced or worked on by members of a labor union nonunion lettuce …   Law dictionary

  • nonunion — [nän′yo͞on′yən] n. failure to mend or unite: said of a broken bone adj. 1. not belonging to a labor union 2. not made or serviced by union workers or under conditions required by a labor union 3. refusing to recognize, or sign a contract with, a… …   English World dictionary

  • nonunion — adjective Date: 1863 1. not belonging to or connected with a trade union < nonunion carpenters > 2. not recognizing or favoring trade unions or their members 3. not produced or worked on by members of a trade union < nonunion lettuce > …   New Collegiate Dictionary

  • nonunion — /non yoohn yeuhn/, adj. 1. not belonging to a labor union: nonunion workers. 2. not recognizing or accepting a labor union or union policy: a nonunion factory. 3. not manufactured by labor union workers. 4. antiunion. n. 5. Med. failure of a… …   Universalium

  • nonunion — adjective not belonging to or not allowing affiliation with a trade union nonunion carpenters a nonunion contractor • Ant: ↑union • Similar to: ↑open, ↑unorganized, ↑unorganised, ↑nonu …   Useful english dictionary

  • nonunion — non|un|ion [ nan juniən ] adjective not a member of a LABOR union a. a nonunion company does not make agreements with LABOR unions …   Usage of the words and phrases in modern English

  • nonunion — non•un•ion [[t]nɒnˈyun yən[/t]] adj. 1) cvb bus not belonging to a labor union 2) cvb bus not recognizing or accepting labor unions: a nonunion factory[/ex] 3) cvb bus not produced by union workers • Etymology: 1860–65 non•un′ion•ist, n …   From formal English to slang

  • nonunion goods — Articles produced by a nonunion shop …   Ballentine's law dictionary

  • nonunion shop — noun 1. : an establishment in which the employer recognizes no labor union and excludes from employment anyone affiliated with a labor union 2. : a shop in which a labor union forbids its members to accept employment * * * a shop or business in… …   Useful english dictionary

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