nonunion

ORIF displaced in young

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

 

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

 

Subtalar and Triple Arthodesis

Biomechanics

 

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

 

Average loss of DF 30% / PF 10%

 

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5o valgus