NONUNION OF FRACTURES CAUSES AND TREATMENT - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing causes and treatment of nonunion fractures.
In nonunion, the healing process of the fracture stops. Failure of fixation of the fracture indicates a nonunion.
Nonunion may be caused by excessive motion of the bony ends and incomplete healing of the fracture. We need stability of the fracture.
Fractures at risk for nonunion:
•Scaphoid
•Proximal femur/ femoral neck fracture
•Fifth metatarsal / Jones fracture
•Open fracture
•The tibia is the common bone to develop nonunion.
Types of nonunions
Hypertrophic “elephant foot”
•Vascular with abundant callus
•Result from inadequate immobilization or fixation.
Oligotrophic
•Vascular with no callus formation
•Not hypertrophic, but are vascular usually occurring after major displacement of a fracture.
Atrophic
•Avascular- no blood supply.
•The ends of the fragments have become osteoporotic and atrophic.
•This type requires bone graft in addition to stabilization of the fracture.
Common causes that may lead to nonunion:
•Smoking
•Diabetes
•Obesity
•Osteoporosis
•Unstable fixation
•Infection
•Open fracture (most common)
•Severe displacement of the fracture (most common)
•Cigarette smoking significantly reduces bone healing rate. Pseudoarthrosis is five times more common in smokers.
Treatment of nonunion
•Conservative treatment may be helpful yet controversial
•Bracing
•Electrical stimulation
•Most nonunions require surgical treatment
•If the ends of the bone appear avascular, then bone grafting may be necessity.
•The goal of surgical treatment is
1-Restore vascularity of the bone
2-Provide stability of the fracture with a plate or a rod
3-Create a healing response by using a bone graft or a bone graft substitute when needed.
•The ideal treatment for humeral shaft nonunion is a plate and bone graft.

[Pete]

I recently had surgery for a trimalleolar ankle fracture. The very first thing my surgeon said to me when we met was, "Are you a smoker?" I replied that I wasn't, and he basically replied, "Good, because I wouldn't do your surgery if you were". I knew there were health risks with smoking, but I never realized it had such an impact on bone healing....glad I never took up that dirty habit.

[Veronica]

Wow, I started to tear up for that poor person at the end of the video. I'm 9 weeks post op from a severe TPF and am praying everything is okay. Still NWB and very scared and alone in my recovery.

[ashishmonga]

ur videos r so awesome. i daily see them for my orthopaedics work knowledge

[nellyhoffman]

Best doctor on youtube !! :) Thanks a lot very helpful

[scizessita]

Thank you, Dr. Nabil. I am now feeling much less anxious about the possibility/probability of non-union of my 8-week-old non-displaced tib-fib fractures. Do you have, or would you consider creating, a video about the role of nutrition in the healing process of a bone fracture? Thanks again.

[sarahkiani]

Dr Nabil means even so much more than these ridiculous kind of so called professors and medical health care here in Belgium with no any knowledge how to treat severe difficult non-union beaks fractures at all.

That's why it would be really excellent if Dr Nabil Abreihim could be making his professions in Belgium hospitals instead please💫🙏🍀

[kaleidoscopekay]

How would a nonunion of the femoral head be treated? A hip replacement?
Very good informative video!

[aurinocastro]

Very important information! Congratulations! 🇧🇷

[chinafox]

very good video! the cause and classification is very useful!
i like it

[yanezzarmasogalao]

DR tibia is hard to treat with a non union fracture??

[erthlyng]

thank you! wish the ortho hand surgeons in my area knew the basics you cover here! :(

[electriciandallastx]

Thanks for the concepts you have discussed here.

[AstroCanbe]

I am doing a research on **** nonunion fractures. It should be an interesting experience with exciting outcomes i hope! thank you for the video

[patrickvanmeter]

10 years ago I got shot in the femur right leg. It shattered about 4-5 inches of the bone. UC San Diego put a rod in. I haven't had any problems and don't even limp. I'm 76 and even run on it. Starting to have a little pain near the hip where they put the screw. Is it possible for the screws or even the rod to get loose or bend?. Don't have pain all the time. Mainly after rebounding or a long walk. I guess an Ex-ray should give me the answers. Do these rods or screws need to be replaced after a few years?

[iLeei]

I have broken my tibia and have a non union been 6 months now since break and still no sign of healing safe to say I'm fed up i need to get bsck to work as been declined sick pay may need another operation yet I don't know what to do

[selerim]

Had a very bad open fracture tibia in the summer, 27 weeks later my tibia is slowly healing but doctor said if not much improved then he'll insert a larger nail rod. However he confident it will improved. I hope so because I hate surgery

[sarahkiani]

Unfortunately here in Belgium all the Professional healthcare seems to be still completely failure in difficult kind of fractures especially according to beaks fractures and that's why I even don't know anymore how to deal with this because no any succesfull medical help for difficult non-union beaks fractures at all here in Belgium still unfortunately

[akomeyam]

I have superior and inferior rami fracture. What would you advice so It would heal?

[mathio]

thank you dr nabil...how can i contact with your all video???

[shivamkhairnar]

What is the alternative way to heal the fracture for non vascular bone ..instead of bone grafting