FRCS Trauma and Orthopaedics Exam: A guide to clinicals and vivas by Mansoor Kassim

Author:Mansoor Kassim
Language: eng
Format: epub
Publisher: eBook Partnership

7. Infected tibial non union. Describe and discuss

What do you understand by non-union?

The cessation of normal biological healing process.

US FDA (Food & Drug administration agency) definition:

fracture that is over nine months old and that has not shown

radiographic signs of progression toward healing for three

consecutive months.

How do you classify non-union?

Lavelle classification:

1. Atrophic – no blood supply, deficient biology

2. Oligotrophic- adequate blood supply but bad reduction (eg-distracted)

3. Hypertrophic- good blood supply and less stability

What are the principles of treatment of infected non-union?

1. Thorough debridement

2. Antibiotics – local (beads)/systemic

3. Soft tissue cover

4. Stabilise bone

5. Bone graft

What are your choices of stabilisation/fixation?

1. External fixator- best

2. Ilizarov –helps with segmental bone defects /bone

transport.

3. Antibiotic-cement coated nails

What are the types of bone grafts/substitutes in tibial non union?

1. Sliding onlay

2. Inlay

3. Fibular

4. Bone marrow injection

5. BMP/ synthetic

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