Non-union Treatment Outcomes in South-East Nigeria
Keywords:
Long bones, nailing, non‑union, outcome, platingAbstract
Introduction: Management of non union of long bones can be challenging and frustrating for the orthopaedic surgeon. In sub Saharan Africa, the bulk of surgeries done by the orthopaedic surgeon may include a significant number of non union of long bones. This is largely because of the strong affinity for seeking treatment from the traditional bone setter as the first on call following fractures in most cases. The orthopaedic surgeon frequently gets to manage the complications arising from such treatment. In managing such cases, adjunctive therapies targeted at increasing union rates which are available to surgeons elsewhere are frequently lacking. Methodology: The study was aimed at determining the outcome of surgeries done for non union of long bones in our institution. It was a retrospective study spanning a 3 year period, from April 2013 to March 2016, involving 80 patients who presented with non union of any of the 3 long bones which had not previously been surgically managed. The patients had surgery with plate / screw construct or a solid intramedullary nail. Outcome measures analysed included occurrence of union, time to union and occurrence of complications with each treatment method for the 3 long bones. Results: We recorded a union rate of 79.2% for all 3 long bones. Majority of the femoral non unions were nailed while the humerus was more commonly plated. The humerus did better with plating than it did when nailed, though nailed non unions were observed to unite faster. Femoral non unions united better when nailed than when plated, though the difference was not statistically significant. Complications rates were higher following plating for femoral non unions. Complications following humeral non union plating were also higher than observed for nailing, with radial nerve palsy occurring in 23.5% of platings. Tibial non unions demonstrated high union rates irrespective of treatment method used. Conclusion: In conclusion, management of non union of long bones is still a challenge with a recurrence rate of 10.8%. Humeral non unions do better when plated as opposed to the femur. Tibial non unions do well with either plating or nailing.
References
Dada AA, Yinusa W, Giwa SO. Review of the practice of traditionalbone setting in Nigeria. Afr Health Sci 2011;11:262‑5.
2. OlaOlorun DA, Oladiran IO, Adeniran A. Complications of fracturetreatment by traditional bonesetters in Southwest Nigeria. Fam Pract2001;18:635‑7.
3. Ogunlade SO, Omololu AB, Alonge TO, Diete ST, Obawonyi JE. Predisposing factors and outcome of treatment of non‑union of long‑bonefractures in Ibadan, Nigeria. Niger Postgrad Med J 2011;18:56‑60.
4. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop RelatRes 1989;241:146-165.
5. Mills LA, Simpson AH. The relative incidence of fracture non‑union inthe Scottish population (5.17 million): A 5‑year epidemiological study. BMJ Open 2013;3. pii: e002276.
6. Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg2016;151:e162775.
7. Chapman J, Weber TG, Henley MB, Benca PJ. Randomized prospectivestudy of humerus fixation: Nails versus plates. Procs Annual Meeting ofthe Orthopaedic Trauma Association; 1995. p. 104‑5.
8. Ayotunde OA, Sunday OK, Oluwatoyin A, Dare OJ. Results ofsurgical treatment of nonunion of humeral shaft fracture with dynamiccompression plate and cancellous bone grafting. Acta Ortop Bras2012;20:223‑5.
9. Crolla RM, de Vries LS, Clevers GJ. Locked intramedullary nailing ofhumeral fractures. Injury 1993;24:403‑6.
10. Cove JA, Lhowe DW, Jupiter JB, Siliski JM. The management offemoral diaphyseal nonunions. J Orthop Trauma 1997;11:513‑20.
11. Yu CW, Wu CC, Chen WJ. Aseptic nonunion of a femoral shaft treatedusing exchange nailing. Chang Gung Med J 2002;25:591‑8.
12. Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA. Theoutcome of closed, intramedullary exchange nailing with reamedinsertion in the treatment of femoral shaft nonunions. J Orthop Trauma2009;23:653‑7.
13. Ong CT, Choon DS, Cabrera NP, Maffulli N. The treatment of opentibial fractures and of tibial non‑union with a novel external fixator.Injury 2002;33:829‑34.
14. Shah SB, Mishra AK, Chalise P, Shah RK, Singh RP, Shrivatava MP,et al. Outcome of treatment of nonunion tibial shaft fracture byintramedullary interlocking nail augmentated with autogenouscancellous bone graft. Nepal Med Coll J 2014;16:58‑62.
15. Waqar H, Ghulam A, Mahmood H. Treatment of nonunion of long bonefractures with surgical implant generation network nail. J Surg Pak2013;18:64‑7.
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Kenechi Anthony Madu, Henry Nnyagu, Osita Ede (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors publishing in the Nigerian Journal of Orthopaedics and Trauma retain the copyright to their work.
All articles are published under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
