WHAT YOU SHOULD KNOW
Failed bone surgery comes in two basic forms: bone not healed at all (non-union) or bone healed in the wrong position (mal-union).Sometimes infection and other issues have also played a role in the failure of the previous treatment. There may be metal hardware left behind in the body.
MEDICAL HISTORY
Patients may complain of pain, deformity, stiffness, weakness, and loss of function. All the details of the original injury and subsequent treatments must be reviewed. The patient should bring the typewritten reports of any previous surgeries that have been performed.
EXAMINATION
The stability of the bones and joints in the involved area will be tested along with all the relevant tendon and nerve functions. The elasticity and quality of the wounds in the area are of importance.
ADDITIONAL TESTS
Sometimes plain x-rays give all the information needed. For non-union cases, occasionally a computed tomography (CT) scan is helpful. When inadequate blood supply is an issue such as non-union of the scaphoid bone in the wrist a magnetic resonance image (MRI) scan provides this critical information.
TREATMENT OPTIONS
| CORRECTIVE OSTEOTOMY | BONE GRAFTING | |
| CONSISTS OF | Cutting the malformed bone to reorient the pieces to the correct relationship | Adding bone content from elsewhere in the body to reform a solid bone |
| FEATURES | Used for both mal-union and some non-unions, usually requires internal fixation hardware to hold new relationship until healed | Can be non-vascularized such as from the hip bone, regional vascularized such as for scaphoid non-unions, or a whole section of leg bone with attached blood supply for major bone reconstructions in the arm (free-fibula flap) |
| ADVANTAGES | Only way to obtain correctly formed bone | Adds needed bone material to achieve healing, vascularized bone also adds the key nutrition to help the healing process |
| DISADVANTAGES | Must achieve healing in new position | Donor site for bone graft required, the more sophisticated the bone graft – the more complex the donor site |
RECOVERY
Free fibula flap cases require a week stay in the hospital for anticoagulant therapy. Bone grafts from the hip usually stay overnight for pain relief. All other cases are outpatient surgery. The reconstructed area is usually immobilized in a splint or cast until follow-up studies indicate that bone healing is occurring on schedule. At that time outpatient rehabilitation is started to regain motion and develop strength. The whole process takes months to occur. Some areas and certain bones heal faster than others.
