Cyril Mauffrey and David J. Hak (eds.)Passport for the Orthopedic Boards and FRCS Examination10.1007/978-2-8178-0475-0_12

Complications of Trauma

Natalie Casemyr¹, Cyril Mauffrey¹ and David Hak¹

(1)

Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, 80204, CO, USA

Cyril Mauffrey

Take-Home Message

Early stabilization of long bone fractures significantly decreases the risk of pulmonary complications, ARDS, fat embolism, and thromboembolic disease
DVT prophylaxis must balance the risk of bleeding with the risk of thromboembolic disease
No regimen of DVT prophylaxis has been shown to decrease the rate of fatal pulmonary embolism

1 Nonunions

Arrest in the fracture healing process with no evidence of progression in bone healing over 4–6 months
Risk factors: inadequate fracture stabilization, poor blood supply (scaphoid, distal tibia, fifth metatarsal, intercalary fragments in segmental fractures), infection, smoking, poor nutritional status, immunocompromise
Classification
- Hypertrophic nonunion: inadequate fracture stability with adequate blood supply, elevated type II collagen, typically heals with improved mechanical stability
- Oligotrophic nonunion: poor reduction with fracture fragment displacement
- Atrophic nonunion: inadequate immobilization and inadequate blood supply
- Septic nonunion
- Pseudarthrosis
Presentation
- Pain with mechanical loading
- Failure of fracture fixation
- Radiographs are the primary study to assess fracture healing
- May consider CT scan if the presence of union is unclear
Treatment
- Identify and treat infection, if present
  
  May require staged approach
- Provide stability for hypertrophic nonunions
- Provide biology for atrophic nonunions
  
  Remove dysvascular bone
  
  Autologous iliac crest bone graft (gold standard, osteogenic), BMPs (osteoinductive), osteoconductive agents
- No strong evidence for the use of ultrasound or electromagnetic devices to stimulate bone healing