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Management of Aseptic Malunions and Nonunions

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Textbook of Polytrauma Management

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Abstract

Evaluation of aseptic non- or malunion requires thorough assessment of the patient and the bone. Treatment involves analysis of the potential causes, correction, or optimization of systemic medical or psychosocial contributors, consideration of non-operative methods, and carefully planned surgery. Occult infection should be sought with history, examination, and appropriate laboratory tests, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Endocrine and metabolic abnormalities are considered and treated. The nonunion should be classified as hypertrophic, atrophic, segmental, or synovial. Non-operative treatments include systemic teriparatide, local injections of growth factors or cells, functional bracing, and bone stimulators. Surgical treatment of malunion will involve osteotomy, which can be done by several techniques. Single-cut oblique osteotomy is a useful and reliable technique for diaphyseal malunions of long bones. Surgical treatment of nonunion will involve a combination of steps depending on the needs of the specific case: removal of hardware, debridement, correction of alignments, internal fixation, and bone grafting. Provision of increased stability by internal fixation with plates or nails is commonly required. Compression of the nonunion site is an important goal. Bone grafting is used for atrophic nonunions or in cases of bone loss. The use of a Reamer Irrigator Aspirator (RIA) to harvest graft from the intramedullary canal is a new method with some advocates.

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Authors and Affiliations

  1. Sadhana Boneworks, Indianapolis, IN, USA

    Jeffrey O. Anglen

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  1. Jeffrey O. Anglen
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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Anglen, J.O. (2022). Management of Aseptic Malunions and Nonunions. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_41

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