Treatment of nonunion of XXXX in the epiphyseal-metaphyseal region of long bones.

@entity1 @entity158 @entity174
Twenty-four consecutive @entity1 with @entity174 nonunion in the metaphyseal-epiphyseal areas of long bones were surgically treated. Average time from injury to treatment of the nonunion was 10 months, and average follow-up time after surgical treatment was 29 months. Eight @entity1 with infected nonunions had initial debridement procedures; three of these @entity1 then had placement of external fixators and bone grafting. The remaining five @entity1 and 13 others were then treated by open reduction and internal fixation alone or with the addition of autogenous cancellous bone grafting. Single or double plates and screws were used. Arthrolysis, joint manipulation, and intensive postsurgical exercises were considered necessary to regain joint function. One @entity1 underwent a hemiarthroplasty, and two others underwent arthrodesis as the initial nonunion treatment. Twenty of the 21 @entity1 not treated by arthrodesis or arthroplasty healed their @entity174 in an average time of 7 months. Fifty-two percent of the @entity1 achieved good or excellent range of motion (ROM) of the contiguous joint, with 70% of the @entity1 reporting no @entity158 in this joint. These @entity174 have excellent intrinsic healing capability because they occur in anatomical regions with a normally abundant circulation. We recommend stable fixation, with the need for bone grafting only in defect nonunions, together with intra- and postoperative joint mobilization to obtain a satisfactory functional end result.
