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Problem Fracture Reconstruction

A fracture is a condition in which there is break in the continuity of the bone. A fracture may be open in which the bone breaks through the skin, or closed in which the bone breaks but there is no puncture in the skin. Overuse can cause stress fractures, which are very small cracks in the bone and are common in foot and ankle. Most broken bones heal without any problems; however some fractures do not heal in the normal period of time, the condition is referred to as nonunion. A delayed union is a condition when fracture takes an exceptionally long time to heal. A malunion is a broken bone that has healed in an imperfect alignment. Most malunions and nonunions require a surgical reconstruction to realign the fracture fragments into their normal anatomic position and to stabilise the fracture site.

Surgical reconstruction includes bone graft or bone graft substitute, internal fixation, and external fixation.

Bone grafts or bone graft substitutes: Bone grafts or bone graft substitutes have the ability to restart the healing process after the normal healing has failed.

A bone graft material provides a framework for the new bone to grow into. It also supplies fresh bone cells and the naturally occurring chemicals that are necessary for normal bone healing. In the procedure an incision is made and pieces of bone are taken or harvested from different parts of the patient's body, usually from the rim of the pelvis or iliac crest. These bone grafts are then transplanted to the nonunion site. The amount of bone harvested does not cause functional, structural, or cosmetic damage to the bone.

Since harvesting bone from a patient can be painful, a second option is to use bone harvested from a cadaver, called an allograft or cadaver bone graft. To minimise the risk of infection to the patient the cadaver bone is processed and sterilised.

In some cases, bone graft substitutes or osteobiologics, which are commercially made products, may also be used. Similar to allograft, bone graft substitutes avoid harvesting from the patient's own healthy bone. They provide a framework for new bone to grow and can be added on with other products that contain the chemicals found in real bone that stimulate growth.

Based on the type of non-union, an autograft (taken from the patient's own healthy bone), allograft, or man-made bone substitutes may be utilised alone or in combination to repair the nonunion. Besides grafting bone to the fracture site, you may also need surgical procedures such as internal or external fixation, to stabilise the fracture site.

Internal fixation: In the internal fixation method, the broken pieces of bone are held in proper position by using metal plates and screws attached to the bone or by placing a rod in the inside canal of the bone while the bone is healing. After internal fixation surgery, if a nonunion arises another internal fixation surgery may be necessary to gain stability. During this surgery a larger rod (nail) or a longer plate (exchange nail) is inserted by removing a previously inserted nail to improve stability and blood flow at the fracture site. Internal fixation surgery can be used in combination with bone grafting to aid healing.

External fixation: External fixation method uses a scaffold-like rigid frame which is fixed outside the injured leg to stabilise the fracture. The frame is fixed to the bone using wires or pins. This method is used to treat nonunions if there is bone loss or chronic infection.

After the surgery, you will need a period of rehabilitation that involves range of motion and strengthening exercises to restore the function.

Dr. Minoo Patel,MBBS, MS, FRACS, PhD - Centre for Limb Lengthening & Reconstruction Dr. Minoo Patel,MBBS, MS, FRACS, PhD - Centre for Limb Lengthening & Reconstruction
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