Abstract
Fifty six cases with non-union or delayed union were treated by us during the past 9 years. The incidence accounted for 7.7% of all the in-patients with bone fracture.
They were 21 cases with the fractured femur, 19 cases with the tibia, 8 cases with the humerus and 8 others. There was only one female. The age distribution indicated the highest in the thirties.
The traffic accident was its major cause, with approximately 60%, and the labor accident and others were the remainder. The compound fracture was found in 17 cases or about 30%. The simple fracture was thus in an unexpectedly high rate.
The etiology of such non- or delayed unions was as follows, according to Dr. Jinnaka's Massif ication, There were the inadequate treatment in 38 cases or about 68% of our series. The impropriety of non-operative reposition and fixation was suspected in 1 case, and that of operative ones suspected in 20 cases, The metallic internal fixation was commonly used combined with the silver wire binding method. Our reflection was called for upon the fact that there were 7 cases where the improper union was presumably attributed to the use of the different type of metals. There were 18 cases in which the improper union was ascribed to the bone fracture itself; the majority of them were of the compound fracture of the tibia.
Surgical therapy was performed upon 51 cases. In 22 cases with delayed union, the fractured stumps were usually freshened and joined by means of the metallic internal fixation. In 29 cases with the bone graft, the fresh autograft was applied. The bone pieces were supplied from their iliac bone in 70%. The fibula was employed mainly to the defect of the injured tibia as an onlay or inlay graft, expecting also the role as its splint.
Cancellous bone materials were preferably used in the graft method, whether the onlay or the inlay graft. The donor bone was usually fixed onto the periosteum of the recipient or its soft tissue with silk sutures, or inlayed into a groove of the recipient bone previously made. The screw fixation was applied to both the ends of the bone in 3 cases treated with the inlay method.
In all the cases with the bone graft, the metallic internal fixation was applied in combination in order not only to reinforce the strength of the fixation but also to shorten the time of gyps fixation.
Our curability was 96%, which was of our considerable satisfaction. There were only 2 cases who failed in our therapy. One of them was the fracture of the cervix of the femur, in which Neufeld's type nail was applied for the fixation and cancellous bone was filled upon freshening the fractured stumps. The other was the fracture of the shaft of the humerus, in which the onlay graft and the metallic internal fixation were applied.
