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Nonunion

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+#REDIRECT [[Nonunion]]
-{{refimprove|date=December 2012}}
-{{Infobox disease |
+{{Redirect category shell|
-  Name           = Pseudarthrosis |
+{{R from merge}}
-  Image          = Nonunion.jpg|
+{{R from alternative name}}
-  Caption        = Hypertrophic nonunion of the tibia |
-  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{{quantify|date=December 2012}} 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. [[United States|U.S.]] [[Food and Drug Administration|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 "pseudo-" 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.
-==Causes of Nonunion==
-#) Causes related to patient:
-## Age: Common in old age
-## Nutritional status : poor
-## Habits : [[Nicotine]] and alcohol consumption
-## Metabolic disturbance : [[Hyperparathyroidism]]
-# Causes related to fracture:
-## Distraction at fracture site
-## Soft tissue interposition
-## Bone loss at the fracture
-## Infection
-## Loss of blood supply
-## Damage of surrounding muscles
-# Causes related to treatment
-## Inadequate reduction
-## Insufficient immobilization
-## Improperly applied fixation devices.
-==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:
-# "Elephant foot" nonunions: These are hypertrophic, rich in callus and are a result of inadequate immobilisation, insecure fixation or premature weight bearing.
-#"Horse hoof" nonunions: Mildly hypertrophic, poor in callus and is due to unstable fixation.
-#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:
-#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.
-#Comminuted nonunions have one or more intermediate fragments that are necrotic.
-#Defect nonunions has a gap in diaphysis of bone due to a loss of fragment.
-# 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 1&nbsp;cm) and Type B (Bone loss of more than 1&nbsp;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 Liizarov, 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 [[Taylor Spatial Frame]] for a description of the modern apparatus.
-[[File:Scaphoid-Pseudarthrose1.jpg|thumb|300px|right|[[Scaphoid bone|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]]