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Nonunion

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+#REDIRECT [[Nonunion]]
-{{Infobox_Disease |
-  Name           = Pseudarthrosis |
+{{Redirect category shell|
-  Image          = Nonunion.jpg|
+{{R from merge}}
-  Caption        = Hypertrophic nonunion of the tibia |
+{{R from alternative name}}
-  DiseasesDB     = |
-  ICD10          = {{ICD10|M|84|1|m|80}}, {{ICD10|M|96|0|m|95}} |
-  ICD9           = |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = |
-  eMedicineSubj  = |
-  eMedicineTopic = |
-  MeshName       = Pseudarthrosis |
-  MeshNumber     = C21.866.404.468.627 |
 }}
-'''Pseudarthrosis''' (or "nonunions") is a fracture that has not united in the stipulated time in which such fractures usually unite and has no chance of union without intervention.There is movement of a [[bone]] at the location of a [[fracture]] resulting from inadequate healing of the fracture. US FDA has set a time period of 9 months for fracture union in order to decide when an intervention is required to facilitate union. Pseudarthrosis can also result from a developmental failure.
-==Etymology==
-The Greek stem "pseud" means false and "arthrosis" means joint.  "Pseudarthrosis", then, is a false joint.  In the case of a 'non-union', a fracture that does not heal, this is often evidenced by the obliteration of the medullary cavity of a long bone at the site of the non union.  This non union is not a true joint, and has no ligamentous support, but often has motion, and remodels into a rounded end that looks like a true joint.
-==Types of Nonunion==
-Judet and Judet, Muller, Weber and Cech, and others classified nonunions into two types according to the viability of the ends of the fragments:- Hypervascular nonunions and Avascular nonunions.
-Hypervascular nonunions are subdivided as: 1. "Elephant foot" nonunions: These are hypertrophic ,rich in callus and are a result of inadequate immobilisation, insecure fixation or premature weight bearing. 2."Horse hoof" nonunions: Mildly hypertrophic, poor in callus and is due to unstable fixation. 3.Oligotrophic nonunions: They are not hypertrophic but vascular, no callus seen and is due to severely displaced fracture or fixation without accurate apposition of fragments.
-Avascular nonunions are subdivided as: 1.Torsion wedge nonunions have an intermediate fragment with decreased or absent blood supply. This fragment has healed to one main fragment but not to the other. 2.Comminuted nonunions have one or more intermediate fragments that are necrotic. 3.Defect nonunions has a gap in diaphysis of bone due to a loss of fragment. 4. Atrophic nonunions usually are the final result when the intermediate fragments are missing and scar tissue that lacks osteogenic potential is left in their place.
-Paley classified tibial nonunions based on clinical and roentgenographic characteristics as Type A (Bone loss of less than 1cm) and Type B (Bone loss of more than 1 cm). Type A is subclassified as Type A:1 Lax type; Lax nonunion have limited mobility and usually some fixed deformity, Type A:2:1 stiff nonunion without deformity and Type A:2:2 stiff nonunion with a deformity. Type B subclassified as Type B:1 bony defect with no shortening, Type B:2 shortening with no gap and Type B:3 there is both gap and shortening.
-==Treatment==
-The point of movement can be treated with electrical stimulations that hopefully will trigger the bone cells to form the [[hydroxyapatite]] structure that keeps bones from bending too much. More recently, non-unions are treated by bone grafting, internal fixation, and external fixation, including a technique pioneered by Ilizarov, used to compress the bones at the site of the fracture.<ref name="pmid18034140">{{cite journal |author=Niedzielski K, Synder M |title=The treatment of pseudarthrosis using the Ilizarov method |journal=Ortop Traumatol Rehabil |volume=2 |issue=3 |pages=46–8 |year=2000 |pmid=18034140 |doi=}}</ref> Ilizarov originally used [[bicycle]] spokes.  See [[Ilizarov apparatus]] for a description of the modern apparatus.
-[[File:Scaphoid-Pseudarthrose1.jpg|thumb|300px|right|Scaphoid pseudarthrosis before and after surgical fixation]]
-'''Grafting'''
-This is using donor bone or autologous bone (harvested from the same person undergoing the surgery) as a stimulus to bone healing.  The presence of the bone is thought to cause stem cells in the circulation and marrow to form cartilage, which then turns to bone, instead of a fibrous scar that forms to heal all other tissues of the body.  Bone is the only tissue that can heal without a fibrous scar.
-'''Fixation'''
-The use of metal plates, pins, screws, and rods, that are screwed or driven into a bone, to stabilize the broken bone fragments.
-==References==
-{{reflist}}
-==External links==
-* [http://www.e-radiography.net/radpath/p/pseudoarthrosis.htm E-radiography]
-* [http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=478&topcategory=General%20Information AAOS]
-{{Osteochondropathy}}
-[[Category:Bone fractures]]
-[[Category:Musculoskeletal disorders]]
-[[Category:Osteopathies]]
+{{Authority control}}
-[[de:Pseudarthrose]]
-[[fr:Pseudarthrose]]
-[[it:Pseudoartrosi]]
-[[kk:Жалған буын]]
-[[lt:Pseudoartrozė]]
-[[nl:Pseudoartrose]]
-[[pl:Staw rzekomy]]
-[[pt:Pseudoartrose]]
-[[ru:Псевдоартроз]]
-[[uk:Несправжній суглоб]]