Strategies in Trauma and Limb Reconstruction

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VOLUME 18 , ISSUE 3 ( September-December, 2023 ) > List of Articles

REVIEW ARTICLE

Universal Long Bone Nonunion Classification

Leonid N Solomin, Anton A Semenistyy, Artem V Komarov, Vladimir V Khominets, Gerard A Sheridan, S Robert Rozbruch

Keywords : Aseptic nonunion, Atrophic nonunion, Bone defect, Bone loss, Classification, Hypertrophic nonunion, Nonunion, Normotrophic nonunion, Oligotrophic nonunion, Pseudarthrosis

Citation Information : Solomin LN, Semenistyy AA, Komarov AV, Khominets VV, Sheridan GA, Rozbruch SR. Universal Long Bone Nonunion Classification. 2023; 18 (3):169-173.

DOI: 10.5005/jp-journals-10080-1597

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim and background: The management of bone union disorders is a complex problem in orthopaedics, requiring a reliable and comprehensive classification system for accurate diagnosis and treatment. Despite advances in understanding pathophysiology, diagnosis, and treatment in this area, there is no generally accepted classification system. The aim of our work was to create a comprehensive classification, which will systemize the vast majority of bone union disorders, underline their differences and form the basis for their treatment. Methods: The key criteria for nonunion evaluation and treatment were identified based on the conducted literature review: Time from the initial event (delayed union or nonunion), location, type of pathology (A, Hypertrophic; B, Normotrophic; C, Oligotrophic) and the presence of hardware. Based on these criteria the ULBNC has been developed. Atrophic nonunions were excluded from this classification as they are considered segmental bone defects with special classification. Results: The ULBNC is based on the same principles of coding as the “gold standard” AO/OTA Fractures Classification system with alpha-numeric coding “from simple to complex.” The choice of treatment method depends on the type, group, and subgroup of the nonunion as described. Conclusion: Universal Long Bone Nonunion Classification (ULBNC) is an alphanumeric system that describes the localization, type of pathology and morphologic characteristics of a nonunion. The use of ULBNC in practice and research will optimize and standardize the treatment of various types of bone healing disorders and eventually improve clinical outcomes.


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  1. Einhorn TA, Gerstenfeld LC. Fracture healing: Mechanisms and interventions. Nat Rev Rheumatol 2015;11(1):45–54. DOI: 10.1038/nrrheum.2014.164.
  2. Solomin L, Komarov A, Semenistyy A, et al. Universal long bone defect classification. Journal of limb lengthening & reconstruction 2022;8(1):54–62. DOI: 10.4103/jllr.jllr_3_22.
  3. Cunningham BP, Brazina S, Morshed S, et al. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury 2017;48(Suppl 1):S69–S75. DOI: 10.1016/j.injury.2017.04.020.
  4. Canbek U, Akgun U, Aydogan NH. Efficacy of bone-end intervention on fracture healing in bisphosphonate-related atypical femoral fractures. Orthop Traumatol Surg Res 2020;106(1):77–83. DOI: 10.1016/j.otsr.2019.07.028.
  5. Weber BG, Oldrich C, Konstam PG. Pseudarthrosis: Pathophysiology, biomechanics, therapy, results. Bern: Hans Huber Publishers; 1976. pp. 323.
  6. Calori GM, Albisetti W, Agus A, et al. Risk factors contributing to fracture non-unions. Injury 2007;38(Suppl 2):S11–S18. DOI: 10.1016/s0020-1383(07)80004-0.
  7. Fong K, Truong V, Foote CJ, et al. Predictors of nonunion and reoperation in patients with fractures of the tibia: An observational study. BMC Musculoskelet Disord 2013;14:103. DOI: 10.1186/1471-2474-14-103.
  8. Brinker MR, O'Connor DP, Monla YT, et al. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 2007;21(8):557–570. DOI: 10.1097/BOT.0b013e31814d4dc6.
  9. Zura R, Mehta S, Della Rocca GJ, et al. Biological risk factors for nonunion of bone fracture. JBJS Rev 2016;4(1):e5. DOI: 10.2106/JBJS.RVW.O.00008.
  10. Paley D, Catagni MA, Argnani F, et al. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res 1989;241:146–165. DOI: 10.1097/00003086-198904000-00017.
  11. Umiarov GA. Classification of nonunions of the long bones complicated by infection and principles of treatment. Sborn Trud CITO 1986;30:5–9. Available at: https://scholar.google.com/scholar_lookup?&title=Classification%20of%20nonunions%20of%20the%20long%20bones%20complicated%20by%20infection%2C%20and%20principles%20of%20treatment&journal=Sborn%20Trud%20CITO&volume=30&pages=5-9&publication_year=1986&author=Umiarov%2CG.A.
  12. Mora R, Maccabruni A, Paparella F, et al. Classificazione e trattamento delle pseudoartrosi infette. Atti SERTOT 1991;33: 205–207. Available from: https://scholar.google.com/scholar_lookup?hl=en&volume=33&publication_year=1991&pages=205-207&journal=Atti+SERTOT&author=Mora+R.&author=Maccabruni+A.&author=Paparella+F.&title=Classificazione+e+trattamento+delle+pseudoartrosi+infette.
  13. Calori GM, Phillips M, Jeetle S, et al. Classification of non-union: Need for a new scoring system? Injury 2008;39(Suppl 2):S59–S63. DOI: 10.1016/S0020-1383(08)70016-0.
  14. Gaddi D, Gatti SD, Piatti M, et al. Non-Union Scoring System (NUSS): Is It Enough in Clinical Practice? Indian J Orthop 2022;57(1):137–145. DOI: 10.1007/s43465-022-00767-5.
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