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Internal fixation of nonunions
E Carlos Rodriguez-Merchan1, Fernando Gomez-Castresana
1La Paz University Hospital, Madrid, Spain. rmerchan@arrakis.es
Clinical Orthopaedics and Related Research
|March 17, 2004
Summary
This review compares plating and intramedullary nailing for treating bone nonunions. Intramedullary nailing is now preferred, especially for long bone nonunions, due to fewer complications.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Bone Healing
Background:
- Nonunions, the failure of bone to heal after fracture, present significant clinical challenges.
- Internal fixation techniques, including plating and intramedullary nailing, are primary treatment modalities.
Purpose of the Study:
- To review and compare the two main types of internal fixation for nonunions: plating and intramedullary nailing.
- To analyze the suitability of each method based on nonunion location (upper vs. lower extremities).
Main Methods:
- Literature review of internal fixation techniques for bone nonunions.
- Comparative analysis of plating and intramedullary nailing, considering advantages and disadvantages.
- Evaluation of technique selection based on nonunion site and characteristics.
Main Results:
- Plating involves open nonunion site access, risking soft tissue damage and infection, and may offer suboptimal fixation in poor bone quality.
- Intramedullary nailing can be performed percutaneously with lower infection risk, but infections can spread systemically.
- Intramedullary nailing has largely replaced plating, except for proximal/distal nonunions, with dynamic locking nails being preferable.
Conclusions:
- The choice between plating and intramedullary nailing depends on nonunion type and location.
- A comprehensive surgical strategy is essential for successful nonunion treatment, often requiring multiple interventions.