Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2017 Jan;30(1):40-51. Korean.
    Published online Jan 20, 2017.
    https://doi.org/10.12671/jkfs.2017.30.1.40
    Copyright © 2017 The Korean Fracture Society. All rights reserved.
    Review

    Impaired Bone Healing Metabolic and Mechanical Causes

    Sam-Guk Park, M.D. and Oog Jin Shon, M.D.
      • Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
    • Correspondence to: Oog Jin Shon, M.D. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: +82-53-620-3640, Fax: +82-53-628-4020, Email: ossoj@ynu.ac.kr

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Non-union is one of the most devastating complications after fracture fixation. It usually results in prolonged treatment duration and unpredictable results. We reviewed the literature to identify recent information regarding the following: risk factors of nonunion; mechanical risk factors, including fracture gap width and stability, osteonecrosis and healing mechanism, osteoporotic fracture and fixation method, the characteristics of fracture, soft tissue injury, local infection, and multiple fractures; as well as the metabolic risk factors, including age, comorbidities, smoking, alcoholism, and medications. The technique and devices for fracture treatment have been developed, and treatments of nonunion are evolving according to the enhancement of our understanding of nonunion. Clinicians should refer to the risk factors and advancements while developing a treatment plan.

    Keywords
    Nonunion; Metabolic; Mechanical

    Figures

    Fig. 1
    (A) Small push and pull movement of the plate can make the non-locked screw loose with marked bone resorption around screw head. (B) The locked screw does not tilt around the axis, consequently the same movement of the plate does not loosen the the screw as much as the non-locked screw. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

    Fig. 2
    The regeneration tissue in the widened gap tolerates the deformation while that in the small gap disrupts the deformation because the strain is about 100% larger. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

    Fig. 3
    (A) The displacement in a simple fracture widens the fracture gap as the same amount. (B) A multi-fragmentary fracture displaced the same amount as the simple fracture. Instead of a simple fracture, multiple gaps share the overall displacement, and the resultant strain is smaller than that of simple fracture.

    Fig. 4
    The divergent locked screws showing better anchorage after application of pull-out load than parallel screws.

    Fig. 5
    When the same bending moment is applied, a long plate produces much less pull-out force than a short plate. Data from the article of Perren (J Bone Joint Surg Br 2002;84:1093-1110).49)

    Notes

    Financial support:None.

    Conflict of interest:None.

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    MeSH Terms
    Alcoholism
    Comorbidity
    Fracture Fixation
    Fractures, Multiple
    Methods
    Osteonecrosis
    Osteoporotic Fractures
    Risk Factors
    Smoke
    Smoking
    Soft Tissue Injuries
    Metrics
    Share
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