NONUNION OF LONG BONES IN BASRAH; EVALUATION AND MANAGEMENT

Abstract

NONUNION OF LONG BONES IN BASRAH; EVALUATION AND MANAGEMENT Thamer A Hamdan* & Mofeed Y Alwaaly@*FRCS, FRCP, FICS, FACS, American Board (Orthopedic Surgery), Professor of Orthopedic Surgery. @MB,ChB, FIBMS, Specialist Orthopedic Surgeon, Basrah Teaching Hospital, Basrah, IRAQ.Abstract Nonunion of long bone fracture holds a big challenge for both the patient and the orthopedic surgeon. This study aimed to explore the possible causes and to evaluate the effectiveness of the treatment of nonunion in our region. Eighty-four patients with established nonunion of long bones were enrolled. All patients with primary fracture underwent; conservative, immediate or delayed operative treatment. Evaluation of nonunion was done by; careful general & local clinical examination, general & specific laboratory investigation, and radiological assessment with special emphasis to classify as atrophic or non-atrophic types. According to treatment modalities of nonunion, the patients were divided into three groups: Conservative (for those who refuse surgery or unfit for anesthesia), early, and delayed operative treatments. From the total 84 patients, 68 patients (81%) were males while 16 patients (19%) were females. Their age range was 13-77 years with a mean of 36.5 years. Five patients (6%) had co-morbidities including; diabetes, bronchial asthma, renal failure, hypertension. Cigarette smoking was not significant (p-value: 0.827). Tibia was the commonest bone involved in nonunion representing 46% (39 patients), followed by femur 36% (30 patients) and humerus 18% (15 patients). Forty-Five patients (54%) developed hypertrophic nonunion while 39 patients (46%) have atrophic nonunion. Non-union in this study was in seventeen cases (20.2%) due to single cause, while in fifty-five patients, (65.5%) due to two causes and the other twelve patients (14.3%) were due to combinations of three causes. Internal fixation with bone graft was performed for thirty patients (36%), external fixation with bone graft was applied to eighteen patients (21%), external fixation alone was done for 14 patients (17%), internal fixation alone was applied to 7 patient (8%), bone graft alone was done for 3 patients (4%), external and mini internal fixation with bone graft was done for 2 patients (2%). The mean time of follow up after definitive treatment for nonunion was 12.4 weeks. The majority of our patients (36 patients, 43%) were followed for 12-24weeks. The commonest bone that showed complete union in this study was femur (48%), tibia (30%), and humerus (22%). In conclusion, the chief causes that stand behind nonunion of the long bones which we revealed by our successive clinical, radiological, labrotary and active operative judgments in this study were; infection, insecure fixation, comminution, and soft tissue interposition. Internal fixation with autogenous bone graft proved to be the vital step to dissolve the obstacle of nonunion.Keywords: nonunion, bones, long, evaluation, treatment