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Diagnosis of Delayed Union and Non-Union

Diagnosis of Delayed Union and Non-Union
  1. Clinical Examination: There may be visible deformity at the site of the fracture. Trauma implants are used by surgeons to join the fractured bone. Siora Surgical Pvt. Ltd. is one of the oldest Indian manufacturers and supplier of orthopedic implants and surgical instruments. This may not be a characteristic feature. Abnormal mobility and localized tenderness are always present over the sites of fractures in cases of delayed union and non-union.
  2. X-ray Evidence: Radiological appearance can be helpful in establishing the diagnosis.

Delayed Union: There is minimal or no callus formation. The fracture line is visible. Sclerosis, which is evident at the site of fracture in case of non-union, is absent in delayed union.

Non-union: Following features may be present in these cases.

  1. Separate Fragments: in some cases, x-ray evidence of non-union is clear by widely separated fragments without any visible communication between the ends.
  2. Smoothness and Sclerosis: The ends of the fragments become rounded by the absorption of the irregular bony projections. Dense sclerosis develops at the sites of fractures.
  3. Callus Formation: There is usually an absence of callus; sometimes minimum periosteal callus formation is seen without any effective tendency to bridge the gap.
  4. Pseudo-arthrosis: False joint may be produced in cases of non-union. The proximal end of the bone fragments becomes convex, while the distal end assumes a concave surface. This condition develops when early movement is allowed before the union is established. This false joint can even be lined with synovial membrane.

Mal-union

Mal-union in most cases can be prevented. This can happen due to non-recognition of the nature of the injury and because of improper management. The seriousness of epiphyseal injury may be overlooked and defect in union is produced. Mal union characterizes in the form of (1) shortening, (2) rotational deformity, or (3) angular deformity.

Also Read: Spinal Fusion Surgery

This may interfere with the functional ability of the segments involved and can produce degenerative changes in the joints.

Shortening: Shortening of the affected part may develop due to following reasons:

  1. Overlapping: Shortening of the bone may be due to the union by overlapping 
  2. Coxa vara: Union of fracture of the neck of femur by-varus deformity will lead to shortening of the lower limb.
  3. Epiphyseal Injury: Epiphyseal injury can interfere with the growth of the bones.

Complications of Shortening: In cases where the lower limb has been affected by shortening, the patient walks with a limp. This produces undue strain over the lumber spine.

Rotational Deformity: This condition develops due to the faulty reduction of the fracture.

Angular Deformity: Deformities of angular variety are of a more serious nature than those of shortening and rotational deformities. Valgus or varus conditions are characteristic of this type of mal-union. Bow leg and cubitus valgus are important examples.

Bowleg: Bowleg can develop following fracture of the tibia. The weight of the body is directed towards a wrong direction. This unusual stress can produce degenerative arthritis of the knee- joint.

Cubitus Valgus: This is the outcome of a mal-united supracondylar fracture. Elbow- joint movement is restricted and friction neuritis of the ulnar nerve is the outcome later.

COMPLICATIONS OF FRACTURE

Complications of fractures can be enumerated as follows:

1. Skin Complications

Abrasions, lacerations and necrosis. 

2. Muscular Complications.

      Rupture laceration.

      Myositis ossificans.

      Rupture of the tendon.

3. Vascular complications:

  1. Contusion, laceration and haemorrhage.
  2. Vascular spasm- Volkmann’s ischaemic contracture.
  3. Venous thrombosis.
  4. Pulmonary embolism.
  5. Fat embolism.

4. Neurological complications

Injuries involving

  1. Intra-cranial structures.
  2. Spinal cord.
  3. Peripheral nerves.

5. Bone complications:

  • Mal-union.
  • Delayed union.
  • Non-union, avascular necrosis of bone, osteomyelitis.
  • Sudeck’s atrophy.
  • Osteoporosis.

6. Joint complications:

  1. Intra and peri-articular adhesions.
  2. Degenerative changes.

7. Visceral injuries:

Abdominal injury.

  1. Gastro- intestinal tract including liver and spleen.
  2. Genito- urinary system:

Kidney, bladder, urethra.

8. Chest Injury:  

  1. Pleura, lung, thoracic cage.
  2. Pericardium and heart.
  3. Large vessels of the neck.
  4. Trachea.

 9. General complications.

  10.Serious Infections:

  1. Tetanus
  2. Gas gangrene.

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