Non-unions and Segmental Bone Defects
Bone consolidation problems following fractures, infections, surgical resections, or other causes are sequelae frequently observed in Orthopedic Surgery consultations. Due to the high tissue healing capacity seen in childhood, these types of issues are more commonly found in adult patients.
They can consist of a simple lack of consolidation (called Non-union or Pseudoarthrosis) or present, in addition, a loss of substance (segmental bone defect), making the problem even more complex.
Frequently, these injuries are also accompanied by limb length discrepancies and/or bone deformities that must also be addressed in the treatment of these patients.
One of the main characteristics of these consolidation defects, especially those of post-traumatic origin, is that they often present associated injuries (vascular, cutaneous, etc.) which makes multidisciplinary treatment even more important.
In the Department of Orthopedic Surgery and Traumatology of the Clínica Universidad de Navarra we have a specialized consultation in Bone Lengthening and correction of Complex Deformities with professionals with great experience in the therapeutic approach of this type of problems.
What is growth plate?
Balance of cellular bone activity
Coordinated activity between osteoblasts and osteoclasts is vital for the maintenance of bone health, mineral balance and bone repair.
- Osteoblasts: These are cells responsible for the formation of new bone tissue. Originating from bone tissue containing stem cells, osteoblasts secrete bone matrix and participate in its mineralization. Osteoblasts are essential in the process of bone growth and fracture healing, as they build and rebuild bone tissue.
- Osteoclasts: These are large, multinucleated cells responsible for bone resorption, i.e., the process of bone tissue breakdown. Osteoclasts break down the bone matrix and dissolve calcium and phosphorus minerals, releasing them into the bloodstream. Osteoclasts help remove old or damaged bone tissue, allowing osteoblasts to replace this tissue with new bone.
When a fracture occurs, the body initiates a healing process in three main phases: inflammation, repair and remodeling.
Initially, the fracture provokes an inflammatory response, generating a blood clot that unites the fractured ends and recruits cells that will form new tissue.
During the repair phase, a soft callus composed of cartilage and fibrous tissue forms around the fracture, which subsequently ossifies to become a hard callus, providing temporary stability.
Finally, in the remodeling phase, the bony callus gradually remodels into new bone, restoring its original shape and function.
This process can take anywhere from weeks to months, depending on the severity of the fracture and the overall health of the individual. Proper alignment and stability of the fracture, along with adequate nutrition and, in some cases, surgical interventions, are crucial for successful healing and proper ossification of the bone.
Do you have a bone consolidation problem?
It may improve with surgical treatment
How are these bone consolidation defects treated?
Treatments to achieve bone union
The treatment of these lesions has as its first objective to achieve a stable fixation and a well vascularized defect environment that favors bone formation, with grafting if necessary.
Once this has been achieved, secondly, our objective will be the correction of associated problems such as dysmetria, deformities, skin coverage, etc.
Bone Transport
This is one of the reconstruction techniques in which our team has more experience. It is a technique specifically designed for the treatment of segmental bone defects as an alternative to the conventionally recommended treatments.
It consists of the detachment of a small bone fragment from one end of the defect, followed by a slow longitudinal transport of this fragment to the other end, while progressive spontaneous ossification occurs in the area of distraction.
For this technique, modified external fixators are typically used to achieve simultaneous consolidation and correction of associated dysmetries and deformities, which is an advantage.
Magnetic endomedullary nails designed for bone transport are now available so that, as in the case of dysmetries, the need for external fixators is eliminated with consequent improved recovery and fewer postoperative complications.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Orthopedic Surgery and Traumatology
of the Clínica Universidad de Navarra
The Department of Orthopedic Surgery and Traumatology covers the full spectrum of congenital or acquired conditions of the musculoskeletal system including trauma and its aftermath.
Since 1986, the Clinica Universidad de Navarra has had an excellent bank of osteotendinous tissue for bone grafting and offers the best therapeutic alternatives.
Organized in care units
- Hip and knee.
- Spine.
- Upper extremity.
- Pediatric orthopedics.
- Ankle and foot.
- Musculoskeletal tumors.
Why at the Clinica?
- Experts in arthroscopic surgery.
- Highly qualified professionals who perform pioneering techniques to solve traumatological injuries.
- One of the centers with the most experience in bone tumors.
Our team of professionals
Specialists in Orthopedic Surgery and Traumatology with experience in treating bone consolidation problems
