principles in the assessment and treatment of nonunions一般原则在评估和骨不连的治疗（ppt66）课件

General Principles in the Assessment and Treatment of Nonunions Hobie Summers, MD and Daniel S. Chan, MD Revised April 2011 Previous Authors: Peter Cole, MD; March 2004 Matthew J. Weresh, MD; Revised August 2006 Definitions Nonunion: (somewhat arbitrary) A fracture that has not and is not going to heal Delayed union: A fracture that requires more time than usual to heal Shows progression over time Definitions Nonunion: A fracture that is a minimum of 9 months post occurrence and is not healed and has not shown radiographic progression for 3 months (FDA 1986) Not pragmatic Prolonged morbidity Narcotic abuse Work-related and/or emotional impairment Definitions (pragmatic) Nonunion: A fracture that has no potential to heal without further intervention “The designation of a delayed union or nonunion is currently made when the surgeon believes the fracture has little or no potential to heal.” Donald Wiss M.D. 22(1): 73-9. Brinker et al. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 2007; 21(8): 557-70. Delong et al. Bone graft and bone graft substitutes in orthopaedic trauma surgery: a critical analysis. JBJS 2007; 89(3): 649-58. Lynch et al. Femoral nonunion: risk factors and treatment options. J Am Acad Orthop Surg. 2008 Feb;16(2):88-97. References 1.Daftari TK, et al. Spine 1995 2.de Vernejoul MC, et al. CORR 1983 3.McKee MD, et al. JOT 2003 4.Schmitz MA, et al. CORR 1999 5.Adams CI, et al. Injury 2001 6.Foulk DA, et al. Orthopedics 1995 7.Dodds RA, et al. Bone 1986 8.Smith TK. CORR 1987 9.Piepkorn B, et al. Horm Met Res 1997 10. Frey C, et al. Foot Ankle Int 1994 11. Perlman MH. Foot Ankle Int 19999 12. Gandhi A, et al. Foot Ankle Clin 2006 13. Jani MM, et al. Foot Ankle Int 2003 14. Murnaghan M, et al. JBJS A 2006 15. Hamid N, et al. JBJS A 2010 16. Giannoudis PV, et al. JBJS - B 2006 17. Butcher CK, et al. Injury 1996 18. Harley, BJ. JOT2002 19. Gustillo, et al. J Trauma 1984 20. Ochsner PE, et al. Injury 2006 21. Weber & Cech. Pseudarthosis 1976 22. Megas P. Injury 2005 23. Bhattacharyya T, et al. JBJS-A 2006 24. Esterhai J, et al. J Orthop Res 1985 25. Esterhai J, et al. CORR 1981 26. Schelstraete K, et al. Acta Orthop Belg 1992 27. Nepola J, et al. JBJS 1993 28. Merkel KD, et al. JBJS 1985 29. Mason MD et.al. Rad. 1989 30. Gristina AG, et al. Instr Cours Lect 1990 31. Kristiansen TK, et al. JBJS-A 1997 32. Gebauer D, et al. Eltrasound Med Biol 2005 33. Friedenberg ZM, et al.JBJS-A 1966 34. Scott G, et al. JBJS-A 1994 35. Helfet D, et al. JBJS-A 2003 36. Rubel IF, et al. JBJS-A 2002 37. Brinker MR. JBJS-A 2007 38. Bosse, MJ e.t.al. JBJS 1989 39. Bellabara C, et al. JOT 2002 40. Ryzewicz M, et al. JBJS-B 2009 41. Heppenstall RB, et al. J Trauma 1987 If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to Thank You Return to General/Principles Index E-mail OTA about Questions/Comments If you