| Objectives:The aim of this study is to analyse the reasons of lower extremity long bone nonunion and to give a brief report of our experience on the treatment of lower extremity long bone nonunion.Methods:42 patients with 42 lower limb long bone fractures treated for nonunion in The Third Hospital of Hebei Medical Universitywere retrospectively reviewed and analysed , from 2009 to February 2010. Of them there were 36 males and 6 females with an average of 35.5 years old(5 to 65 years old).The shortest nonunion were seven months and the longest were four years with the an average time of 11.6 months.Classification of the fractures according to whether the injures were closed or open were divided into closed(28 cases) or open according to Gustilo classification (3 cases of I type, 4 cases of II type,1 cases of IIIA type,4 cases of IIIB type,2 cases of IIIC type); nonunion site by the existence of cases of infection will be classified in this group(19 cases of infection,23 cases of no-infection; by Weberh-Cech [1] of this group of cases of nonunion classification(6 cases of atfophic nonunion,3 cases 0f hypertrophic nonunion).Results : Nonunion contributed by inappropriate immobilisation presented in 18 cases,whereas 19 cases were caused by infeetion,19 fractures were caused by traffic accident.Operations to achieve union ranged from one to four in number.Grafting procedure was done when there was insufficient evidence of bony union.The average time of fracture nonunion as shown by x-ray and clinical evaluation ranged from 6 months to 4 years with a mean 11.5 months.Among them 3 patients were los(t7.1%),so the final result does include such data.The remaining 42 cases of 42 limb fracture union,12 patients still in follow up.Conclusion:The lower segment of the tibial fractures has a very high risk tendency to end in nonunion,while in the femoral neck nonunion higher incidence of nonunion. There is always a high risk to infection that can contribute to delayed fracture union and nonunion.Seriously injured lower limb long bone with severe comminution, fracture location and disturbed blood supply to the bone still plays a main role in deciding the outcome and progression of most cases of bone nonunion. Iatrogenic factors such as internal fixation the improper use and the defect exercise also contribute to nonunion. |
