Nonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society

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dc.contributor.authorSchmal, Hagenen_ZA
dc.contributor.authorBrix, Michaelen_ZA
dc.contributor.authorBue, Matsen_ZA
dc.contributor.authorEkman, Annaen_ZA
dc.contributor.authorFerreira, Nandoen_ZA
dc.contributor.authorGottlieb, Hansen_ZA
dc.contributor.authorKold, Sorenen_ZA
dc.contributor.authorTaylor, Andrewen_ZA
dc.contributor.authorTengberg, Peter Toften_ZA
dc.contributor.authorBan, Ilijaen_ZA
dc.contributor.authorDanish Orthopaedic Trauma Societyen_ZA
dc.date.accessioned2023-01-18T11:08:09Zen_ZA
dc.date.available2023-01-18T11:08:09Zen_ZA
dc.date.issued2020-01en_ZA
dc.descriptionCITATION: Schmal, H. et al. 2020. Nonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society. EFORT Open Reviews, 5:46-57, doi:10.1302/2058-5241.5.190037.en_ZA
dc.descriptionThe original publication is available at https://eor.bioscientifica.comen_ZA
dc.description.abstractNonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as ‘mechanobiology’ or the ‘diamond concept’ determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding absolute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteoconductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction.en_ZA
dc.description.versionPublisher's versionen_ZA
dc.format.extent12 pagesen_ZA
dc.identifier.citationSchmal, H. et al. 2020. Nonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society. EFORT Open Reviews, 5:46-57, doi:10.1302/2058-5241.5.190037.en_ZA
dc.identifier.issn2058-5241 (online)en_ZA
dc.identifier.otherdoi:10.1302/2058-5241.5.190037en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/126237en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherBioscientificaen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectFractures -- Treatmenten_ZA
dc.subjectInternal fixation in fracturesen_ZA
dc.subjectTraumaen_ZA
dc.titleNonunion – consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Societyen_ZA
dc.typeArticleen_ZA
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