After a person has a bone fracture, most often this happens with the lower or upper extremities, the fusion may be incorrect. In this case, the bone changes its correct anatomical position. Quite often, the reason that the fracture has not grown correctly is the lack of fixation of fragments in the cast. But this is not the only reason.
How bone fusion occurs
Incorrectly, a fracture in any part of the body can heal . More often this occurs with fractures of the jaw, hands and fingers. An abnormally fractured leg fracture is much less common.
Immediately after the disaster has occurred, damage recovery begins in the human body. This process consists of two stages. At the first stage, the resorption of those tissues that died when injured occurred, and during the second stage, the bone itself is restored.
It takes a certain amount of time for the bone to grow together. During the first week, the formation of a special tissue called granulation occurs. This tissue attracts minerals to itself, which leads to the loss of excess fibrin filaments. Later, collagen fibers appear, due to which the bone is formed in the form in which it should be. Every day more and more mineral salts accumulate at the fracture site, which helps the formation of new bone tissue.
If you take an x-ray in three weeks, then you can see the bone marrow at the site of accretion. The fact that the fracture does not grow together correctly can be detected with the help of x-rays at this stage. What to do with an incorrectly fused fracture is decided in each individual case in different ways.
Causes of Incorrect Fracture Fusion
Fractures can be of two types - closed and open. Closed is not as dangerous as open. It quickly grows together, and the reason that the fracture is not properly healed is only improper treatment. It is bad when the fracture is open, there are cases when osteomyelitis develops. Or a wound infection occurs.
What did not grow together correctly in a broken arm? Why did it happen? The reasons may be as follows:
- Errors were made during treatment.
- A bone displacement occurred in the cast.
- No bone adjusting loops were installed.
- During surgery, fixators were not established according to morphology.
Most often, the fracture has not grown together correctly due to any mistakes made during the treatment period. If in the area where the injury occurred, the person is worried about something, and he suspects that the bones are not growing together correctly, you should contact a traumatologist to confirm or refute this fact.
The most common problem is an abnormally fractured radial bone fracture. Therefore, with such an injury during bone repair, you need to be especially careful so that there are no problems later.
If it happened that a radiation fracture did not grow together correctly, then this pathology is treated as well as fractures in other places.
Surgical treatments
If abnormal bone fusion occurs, it is usually treated surgically. Orthopedic operations are of three types:
- corrective osteotomy,
- osteosynthesis
- marginal bone resection.
Corrective osteotomy
Such an operation is performed under general anesthesia. Its ultimate goal is to eliminate bone deformation. To achieve this, you again have to break a bone that has grown together incorrectly. It is broken with the help of surgical instruments, dissected by radio waves or a laser.
Fragments of bones are again connected to each other in the correct position and secured using special screws, knitting needles, plates and more. During such an operation, the principle of traction can be used. To the spoke, which is located in the bone, the load is suspended, which stretches the bone, and it occupies the position that is necessary for normal splicing.
Types of Osteotomy
The type of osteotomy can be open and closed. In the process of open intervention, a skin incision is made 10-12 centimeters, which opens the bone. Then the surgeon separates the bone from the periosteum and dissects it. Sometimes this is done through specially drilled holes.
With the closed method of this operation, the skin is cut only 2-3 centimeters at the site of the injury. After that, the surgeon cuts the bone with a surgical tool only ¾, and the rest is broken. During such an intervention, large vessels and nerves are sometimes seriously damaged, so an open-type osteotomy is still more often performed.
Corrective osteotomy is most often used to correct an incorrectly healed fracture on the lower or upper limbs. Thanks to this operation, the patient's legs move, and the hands perform all the movements that are inherent in them.
Contraindications osteotomy
This type of operation is prohibited if the patient has the following diseases:
- Severe diseases of the kidneys, liver, and other internal organs.
- Pathology of the heart and blood vessels.
- If at the time of surgery the patient has an acute or exacerbation of a chronic disease.
- Purulent infection of organs or tissues.
Complications after surgery
As after any other surgical intervention, there may be complications after an osteotomy, namely:
- If an infection gets into the wound, it can cause suppuration.
- The appearance of a false joint.
- Slowing fracture fusion.
- Displacement of bone fragments.
Osteosynthesis operation
This is a very popular way to treat fractures that have not grown together correctly. The essence of this operation is that fragments of a broken bone are attached to one another using various fixatives. They can be in the form of special screws, screws, knitting needles, etc. The fixators are made of strong non-oxidizing material, it can be bone tissue, special plastic, stainless steel, titanium and other materials.
Implants are used for a long time, which allows the bone at the fracture site to fully recover.
Osteosynthesis can be of two types:
- Outside, it is also called transosseous. During such an operation, bone fragments are connected. Outside, everything is fixed using the Ilizarov apparatus or other similar devices.
- Internal (submersible). This method differs from the previous one in that the implants fix the bones inside the body, and not outside. After this operation, additional fixation is often carried out with a plaster cast.
Osteosynthesis is usually used in cases where it is necessary to connect the long tubular bones of the legs (thigh, lower leg) and hands (shoulder, forearm), as well as fractures of the joints and small bones of the hand and foot.
Fixation during osteosynthesis keeps broken bones stationary, and therefore they grow together correctly.
Contraindications for this operation
Such surgical intervention as osteosynthesis, despite many positive aspects, also has some contraindications. For instance:
- The patient is in serious condition.
- An infection or dirt has got into the wound.
- Large area of damage if fracture is open.
- The patient has an ailment, which is accompanied by convulsions.
- The presence of osteoporosis, in which the bones become very fragile.
Possible complications
To fix the bone, the surgeon has to expose a large area of the bone. At the same time, she loses the surrounding tissues in which the blood vessels are located, and this leads to a violation of her blood supply.
During the operation, nearby tissues and bones are damaged. Also, the large number of holes that are needed for screws and screws weaken the bone.
If antiseptic precautions are not followed, infection can get into the wound.
Partial bone resection
During this operation, the damaged area of the bone is removed. Resection can be performed as a separate operation, or it can only be a certain stage of another surgical intervention.
Partial resection can be of two types:
- Subperiosteal With this method, the surgeon using a scalpel cuts the periosteum in two places - above the lesion and under it. Moreover, this should be done in the place where healthy and damaged tissues are joined. After this, the periosteum is separated from the bone and sawn from below and above.
- Transperiosteal. The operation is done in the same way as the previous one, the only difference is that the periosteum is exfoliated not in the direction of a healthy area, but in the affected area.
Resection is performed under general or conduction anesthesia.