Overview
Nonunion following arthrodesis refers to the failure of bone healing after surgical fusion procedures, leading to persistent pain, instability, and functional impairment 3.Diagnosis
Persistent pain and lack of radiographic evidence of bone union beyond the expected healing period 3.
Clinical examination revealing abnormal mobility or signs of mechanical irritation 3.
Radiographic imaging (X-rays, CT, MRI) to confirm absence of union and assess for hardware issues 3.Management
First-line treatments: Revision surgery, including the use of double plates bolted together for tibial nonunions, has shown higher success rates compared to single plates 3.
Adjunctive therapies: Low-intensity pulsed ultrasound (LIPUS) may be considered for scaphoid nonunions post-surgery, though evidence is limited and primarily observational 1.
Specific interventions: Proximal hamate graft for proximal scaphoid reconstruction can restore native wrist kinematics, improving functional outcomes 2.Special Populations
Pediatrics: Not addressed in provided abstracts.
Elderly: Not specifically discussed; however, functional outcomes noted as "fair" in healed cases of tibial osteotomy 3.
Comorbidities: No specific guidance provided for patients with comorbidities in the given abstracts.Key Recommendations
For tibial nonunion following osteotomy, consider using double plates bolted together to enhance union rates (Evidence: Moderate 3).
In scaphoid nonunions, postoperative application of LIPUS may be beneficial, though further high-quality evidence is needed (Evidence: Weak 1).
Proximal hamate graft reconstruction can effectively restore wrist kinematics post-scaphoid nonunion surgery, improving functional outcomes (Evidence: Moderate 2).References
1 White NJ, Patterson ED, Dhaliwal GS, Hildebrand KA. Low-Intensity Pulsed Ultrasound Versus Sham in the Treatment of Operatively Managed Scaphoid Nonunions: The SNAPU Randomized Controlled Trial. The Journal of bone and joint surgery. American volume 2024. link
2 Burnier M, Gil JA, Hooke A, Elhassan B, Kakar S. Does Proximal Hamate Graft for Proximal Scaphoid Reconstruction Restore Native Wrist Kinematics?. Hand (New York, N.Y.) 2023. link
3 Cameron HU, Welsh RP, Jung YB, Noftall F. Repair of nonunion of tibial osteotomy. Clinical orthopaedics and related research 1993. link