nonunion

Displaced ORIF

Indications

 

< 60 with good bone stock and preserved joint space

 

Reduction

 

Union rates increased with anatomical reduction

 

Options

- closed reduction

- open reduction / if closed reduction fails

 

Accept

- no varus

- < 15o valgus

- < 10o AP plane

 

Non Union

Definition

 

Non-union

- arrest of progression to union at fracture site 

- > 6-9 /12

- no visible progressive signs of healing for at least three consecutive months

- individualise for each fracture

- when the surgeon believes the fracture has little or no chance to heal

 

Delayed union

- failure of fracture to unite within expected time

- still may spontaneously unite

 

Complications

Undercorrection /  loss of correction 

 

Most important factor in good results and duration of results

- must correct to 8o of valgus

- mechanical axis must pass through lateral joint line

 

HTO Insufficient Correction

 

Causes

- inadequate initial correction

Management

Acute management

 

Resuscitation

 

EMST

Neurovascular assessment

Investigations - exclude Pipkin, NOF

Emergent reduction / skeletal stabilisation

Assess stability

Re-evaluate sciatic nerve

 

Insertion Femoral Steinman Pin

 

Indications

- displaced acetabular fracture