nonunion

　 　

WordNet

1. not belonging to or not allowing affiliation with a trade union; "nonunion carpenters"; "a nonunion contractor"

PrepTutorEJDIC

1. 労働組合に加入しない / 労働組合員を雇っていない

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/17 03:26:52」(JST)

wiki en

[Wiki en表示]

For the meaning in organized labour, see Trade union.

Nonunion is permanent failure of healing following a broken bone.

Nonunion is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is interrupted or stalled. In some cases a pseudo-joint (pseudarthrosis) develops between the two fragments with cartilage formation and a joint cavity. More commonly the tissue between the ununited fragments is scar tissue.

Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in a very few cases. In general, if a nonunion is still evident at 6 months post injury it will remain unhealed without specific treatment, usually orthopedic surgery. A non-union which does go on to heal is called a delayed union.

Clinical features

A history of a broken bone is usually apparent. The patient complains of persistent pain at the fracture site and may also notice abnormal movement or clicking at the level of the fracture. An x-ray plate of the fractured bone shows a persistent radiolucent line at the fracture. Callus formation may be evident but callus does not bridge across the fracture. If there is doubt about the interpretation of the Xray, stress Xrays, tomograms or CT scan may be used to make sure.

Pathophysiology

The reasons for non-union are

• avascular necrosis (the blood supply was interrupted by the fracture)
• the two ends are not apposed (that is, they are not next to each other)
• infection (particularly osteomyelitis)
• the fracture is not fixed (that is, the two ends are still mobile)
• soft-tissue imposition (there is muscle or ligament covering the broken ends and preventing them from touching each other)

Hypertrophic non-union

Callus is formed, but the bone fractures have not joined. This can be due to inadequate fixation of the fracture, and treated with rigid immobilisation.

Atrophic non-union

No callus is formed. This is often due to impaired bony healing, for example due to vascular causes (e.g. impaired blood supply to the bone fragments) or metabolic causes (e.g. diabetes or smoking). Failure of initial union, for example when bone fragments are separated by soft tissue may also lead to atrophic non-union. Atrophic non-union can be treated by improving fixation, removing the end layer of bone to provide raw ends for healing, and the use of bone grafts.

Untreated prognosis

By definition, a nonunion will not heal if left alone. Therefore the patient's symptoms will not be improved and the function of the limb will remain impaired. It will be painful to bear weight on it and it may be deformed or unstable.

Treatment

Surgical treatment includes removal of all scar tissue from between the fracture fragments, immobilization of the fracture with metal plates, rods and or pins and bone graft. In simple cases healing may be evident within 3 months. Gavriil Ilizarov revolutionized the treatment of recalcitrant nonunions demonstrating that the affected area of the bone could be removed, the fresh ends "docked" and the remaining bone lengthened using an external fixator device. The time course of healing after such treatment is longer than normal bone healing. Usually there are signs of union within 3 months, but the treatment may continue for many months beyond that.

Treated prognosis

This depends on many factors including the age and general health of the patient, the time since the original injury, the number of previous surgeries, smoking history, the patient's ability to cooperate with the treatment. In the region of 80% of nonunions heal after the first operation. The success rate with subsequent surgeries is less.

See also

• Distraction osteogenesis

External links

• Dr. Dror Paley Informational site (Ortho conditions section includes video of limb lengthening methods including non union) .
• Non_union at the Duke University Health System's Orthopedics program
• William D. Terrell non-union

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 骨折のマネージメントの一般原則：早期および後期合併症 general principles of fracture management early and late complications
• 2. 成人における脛骨骨折の概要 overview of tibial fractures in adults
• 3. 確実な骨折マネージメントの一般原則 general principles of definitive fracture management
• 4. 成人における上腕骨骨幹部骨折 midshaft humeral fractures in adults
• 5. 成人における大腿骨骨幹部骨折 midshaft femur fractures in adults

English Journal

• Efficacy of platelet concentrates in bone healing: A systematic review on animal studies - Part B: Large-size animal models.

• Marcazzan S1,2, Taschieri S1,3, Weinstein RL4, Del Fabbro M1.
• Platelets.Platelets.2018 Jun;29(4):338-346. doi: 10.1080/09537104.2017.1384537. Epub 2017 Dec 5.
• PMID 29206070

• The indications and donor-site morbidity of tibial cortical strut autografts in the management of defects in long bones.

• Lauthe O1, Soubeyrand M2, Babinet A1, Dumaine V1, Anract P3, Biau DJ3.
• The bone & joint journal.Bone Joint J.2018 May 1;100-B(5):667-674. doi: 10.1302/0301-620X.100B5.BJJ-2017-0577.R2.
• PMID 29701102

• 'Rail and Nail' bifocal management of atrophic femoral nonunion.

• Davda K1, Heidari N2, Calder P1, Goodier D1.
• The bone & joint journal.Bone Joint J.2018 May 1;100-B(5):634-639. doi: 10.1302/0301-620X.100B5.BJJ-2017-1052.R1.
• PMID 29701097

Japanese Journal

• Distal radius nonunion after volar locking plate fixation of a distal radius fracture : a case report

• Nagoya Journal of Medical Science 79(4), 551-557, 2017-11
• NAID 120006365324

• 癒合不全と変形癒合の治療法 (特集 トイ犬種の橈骨尺骨骨折) -- (トイ犬種の橈骨尺骨骨折治療アドバンス)

• Surgeon : technical magazine for veterinary surgeons : 小動物外科専門誌 21(5), 85-96, 2017-09
• NAID 40021344332

• 鎖骨骨折における手術成績 (創刊60年記念特集 肩関節外科の進歩)

• 整形・災害外科 60(10), 1325-1330, 2017-09
• NAID 40021321811

Related Links

• nonunionの意味 - goo辞書 英和和英

「nonunion」の意味 このページの先頭へ 国語辞書 デジタル大辞泉 文学 宗教・思想 日本史 世界史 地理 社会 美術・音楽 演劇・音楽 物理・化学 生物 地学 医学 生活 数学 IT用語 四字熟語 慣用句・ことわざ ABC略語 季語 品詞 類語辞書 ...

• Nonunion - When Your Broken Bone Doesn't Heal

A nonunion occurs when a broken bone does not heal. Bones have a tremendous capacity for healing themselves, and with proper treatment, most all fractures will heal without complication. However, some fractured ...

Related Pictures

---

★リンクテーブル★

リンク元

「偽関節」

「偽関節」

　　[★]

英

nonunion(SOR), non union, pseudarthrosis

関

仮関節

• 骨折部の癒合過程が止まって、異常可動性を示す場合(SOR.627)。
• 関節包内骨折、周囲に筋組織が少ない部位での骨折に起きやすい

• 大腿骨頚部(頚部内側)、手の舟状骨(scaphoid)、脛骨骨幹部(中下1/3)、軸椎歯突起、上腕骨外顆