Surgical Treatment of Non-Union and Delayed Union of Long Bones

Interest in the treatment of false joint has increased since the Second World War, as in the periods following all wars.The large fractures caused by shell-splinters, and often complicated by serere infection, frequently lead to formation of pseudarthrosis with large bony defect, the treatment of which must still be looked upon as an unsolved problem in many respects.Formerly, in normal times, pseudarthrosis of the long bones was considered fairly rare, but today there seems to be an increased frequency, even after peace-time fractures.This is a phenomenon which has been reported from numerous quarters, and upon reflection, the occurrence seems rather strange.There are now means by which infections affecting large shell-splinter fractures may be combatted and the methods for treatment of fractures in general have been developed and constantly improved over a period of tens of years.Without doubt, one of the reasons for the increased frequency of false joint is the rising number of severe road and industrial accidents.Open splinter-fractures are often sustained in these accidents, and, in size, almost comparable with war-time fractures.Whether or not modern fracture treatment as such, particularly if erroneously applied, may be contributive in this respect is an open question.There are two important circumstances due to which pseudarthrosis is liable to develop : inadequately supervised traction treatment which readily causes too wide a distraction between the fragments, resulting in diastasis, and, too brief a period of immobilization.Numerous authors have stressed these two points.(Bohler, Bafzner, Kaspar, Nusself, and others).Another question is whether the metal osteosyntheses contribute to the increased frequency of false joint.In these operations, large areas of the bone around the fracture are often laid bare, infections I. Surgery of Beck's type with boring, and Kirschner's fragmentation.An endeavour is made to stimulate formation of new bone by refreshing the site of fracture.These methods are best suited to eases of delayed union and may he attempted, as no great risk is involved.However, in most cases there is no response; this is seen from the fact that previous use of these methods is often recorded in the histories of patients with pseudarthrosis.The results are generally poor if fully developed pseudarthrosis is present.11.This group contains cases in which wires are inserted through the fragments for the purpose of compressing the ends of the fragments, according to