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Revision of failed posterior cervical fusions
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Trevor Mordhorst, Vadim Goz, William Ryan Spiker
Pseudarthrosis is a well-known etiology of recurrent symptoms after posterior cervical fusion surgery, and it can necessitate revision. Both patient-related and operative factors contribute to the risk of developing a nonunion. Surgical factors that affect the rates of pseudarthrosis include type of graft and graft adjuncts used, stability/rigidity of the construct, number of levels included in the construct, and surgical technique of fusion bed preparation. Reviewing these factors can help to stratify patients based on their risk for developing pseudarthrosis.
Optimizing Metabolism to Treat Fractures and Prevent Nonunion
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Jacob Wilson, Scott Boden, Kenneth Cintron, Mara Schenker
A nonunion may be diagnosed when fracture healing has ceased and there is no chance of bony union without further intervention.10,11 It is worth noting that no consensus definition of nonunion has been agreed upon. Regulatory groups including the United States Food and Drug Administration (FDA) have attempted a temporal definition—a nonunion being defined as diagnosed at a minimum of 9 months, with 3 months of no visible progression of healing.11 This, however, represents an over-simplification as certain patient factors and comorbidities can contribute to a delay in union; therefore, nonunion must be diagnosed with the specific fracture and patient factors in mind. Clinically, nonunions are marked by continued pain and pathologic motion at the fracture site. Radiographically, there will be lack of bridging bone on all four cortices,12 persistence of lucency at the fracture site, and sometimes sclerosis on either side of the fracture. Nuclear scans, such as technetium scintigraphy, have also been shown to have reasonable sensitivity and specificity for detecting nonunions and are useful adjuncts.13
Musculoskeletal cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
• Nonunion is the failure of a fracture to heal. OA, pain, and limitation of movement may result.Is any further imaging required?
Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Octavian Andronic, Raffael Labèr, Philipp Kriechling, Daniel Karczewski, Andreas Flury, Ladislav Nagy, Andreas Schweizer
Apart from the fixation technique, further elements need to be explored, because they influence the results. Nonunion may be caused by incomplete removal of the cartilage and subchondral bone, which is a key step of the procedure [7,40]. Also, the importance of using bone grafts, its quality, compression and carpal height achieved [44], as well as the location (distal radius) need to be elucidated, as they might play an important role in the success of fusion [45]. Another issue that is leading to revision is implant impingement, occurring mostly with dorsal plates. Optimal placement has to be defined in future studies to avoid surgical revisions because of impingement [46]. Furthermore, it should be noted that studies used different types of assessment of radiographic fusion: the majority [26] used conventional radiographs, 2 studies [14,40] also performed CT scans in case of doubt and only one study has performed CT scans in all patients to confirm fusion [39]. We believe that both assessment modalities were sufficient into diagnosing a successful fusion when correlated with the clinical picture of a pain-free osteosynthesis. There is scarce literature regarding the optimal radiological assessment of midcarpal fusion but Henry M. and Ekelund et al. reported a clear advantage of CT scans [47,48]. However, in order to avoid methodological heterogeneity, equivalent outcome measurement techniques should be employed in future studies.
A meta-analysis of union rate after proximal scaphoid fractures: terminology matters
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Han Hong Chong, Kunal Kulkarni, Rohi Shah, Melinda Y. T. Hau, Lambros Athanatos, Harvinder Pal Singh
For waist fractures, there is evidence to suggest that displacement is associated with instability and non-union, with operative management (fixation) advocated to minimise non-union [1,51,52]. However, a combination of diagnostic difficulty due to poor visualisation of the fracture on plain radiographs, inter-observer variation in classification (varying definition of the boundaries between waist and proximal) and finally, the differences in fracture configuration (transverse vs oblique) leads to differences in treatment, contributing to the heterogeneity in reported outcomes. The task becomes more complex when proximal fractures are considered, with less evidence to guide management. The goals of treatment are to prevent the sequelae of non-union and osteonecrosis. As non-union of proximal scaphoid fractures is more likely to progress to degenerative changes (SNAC) than their distal counterparts, operative management is usually recommended [53,54].
LncRNA SNHG1 Delayed Fracture Healing via Modulating miR-181a-5p/PTEN Axis
Published in Journal of Investigative Surgery, 2022
Xiuquan Guo, Jialiang Zhang, Xuemei Han, Ganggang Wang
Fractures are common worldwide, with an annual incidence of 0.25%–0.38% [1,2]. Although most fractures will heal after surgery, delayed healing or non-healing still occurs in 5%-10% of patients, causing pain, disability, psychological disorders, and a huge financial burden [3]. The current best treatment for nonunion and delayed healing is autologous bone grafting, but the limited availability of own bone implants increases the incidence of adverse effects [4]. Since fracture healing is a long-term biological repair process, which osteocytes, inflammatory cells, blood supply, and cytokines surrounding the fracture site play an important role in the whole process of fracture healing [5]. Whereas osteoblasts are key regulators of bone formation, enhancing osteoblast production and inhibiting their apoptosis may accelerate bone healing, while inhibiting osteoclast differentiation may lead to delayed or even arrested bone healing [6]. Therefore, there is a need to have an in-depth understanding of the delayed process of fracture healing at the molecular level and to find appropriate methods for early intervention and treatment to help patients accelerate the recovery of fracture healing.