Nonunion of the long bone fracture in lower extremities is relatively common. A number of methods of stimulating union after early failure have been described. These include fibular osteotomy followed by weight-bearing in a case, autogenous bone
grafting with or without additional stabilization, internal or external fixation with compression, open or closed intramedullary nailing and even electromagnetic stimulation.
The factors of nonunion have been known as infection, extensive soft tissue injury, interposition of the soft tissue, disturbance of the blood supply and inadequate fixation.
Cave has defined nonunion as a fracture in which the reparative process have come to a complete standstill.
In this paper we carried out retrospective study of the 24 nonunion of the long bones of the lower extremities, who were treated at the department of Orthopaedic Surgery, Lee-Rha general Hospital from August 1989 to November 1991, to find out the
relationship between type of fracture and type of nonunion, and the causes of the nonunion of the tibia and femur.
@ES The results were as follows:
@EN 1. Among 24 cases of nonunion, 18 cases(75.0%) were comminuted fractures, and 13 (86.7%) out of 15 cases of tibial nonunion were open fractures and only one case of 9 femoral nonunion was open fracture.
2. Hypervascular nonunion were 14 cases and avascular nonunion were 10 cases, hypervascular nonunion was prevalent in femur: 7(77.8%) out of 9 cases of femoral nonunion were hypervascular, while 8(53.3%) of 15 cases of tibial nonunion were
avascular
nonunion.
3. All of femoral nonunion were treated with interlocking nail, and tibial nonunion were treated with intramedullary nailing (8 cases), dynamic compression plate and screws(2 cases), monofixateur(1 cases), Ilizarov oxternal fixation device (2
cases),
multiple Kwires(1 cases), and modified Huntington's operation(1 case).
4. The average duration from injury to diagnosis of nonunion was 9.4 months (range, 4 months to 39 months).
5. The main causes of the nonunion were failure of anatomical reduction of medial buttress at the fracture site, insecure internal fixation, insufficient external fixation, impaired blood supply of the fracture ends, and combined.
6. One case of the femoral nonunion which was induced by the failure of interlocking nail, had metal failure through the proximal hole of the distal screw holes.
7. Average time of union was 20.5 weeks in femur, and 28.7 weeks in tibia. All cases were united at average 24.6 weeks.
8. Excellent or good results were achieved in all patients, who were treated with intramedullary nailing without complications.
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