Müller, Clin Orthop Relat Res 1965 - Treatment of Nonunions by Compression

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Treatment of Nonunions by Compression

Müller·Clin Orthop Relat Res·1965·74 citations·Case series

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Muller reports a 100-case series treating long-bone shaft nonunions with rigid internal fixation. Compression plating and intramedullary nailing are the two main methods, with grafting reserved for select cases. The paper defines when each technique and when a bone graft is indicated.

Key Findings

97 of 100 long-bone shaft nonunions united after a single operation with rigid internal fixation. All 3 failures were traced to a specific technical error, and every one of them united after revision with a nail.
The three failures teach the technical rules directly: a tibial plate placed on the medial (compression) side with varus, two plates across an inert femoral pseudarthrosis without a graft, and a nail that was too thin. Get these right and the construct works.
The Judet distinction drove graft decisions:
- Hypervascular ('elephant's foot') pseudarthrosis: viable, no graft needed.
- Avascular (inert bone ends): always needs a cancellous graft.
Interfragmentary compression increased plate stability by a factor of 1 to 10 and closed the fragment gap. In 30 ungrafted cases, ossification was faster than without compression.
No case needed plaster. Joints were mobilized on the 2nd or 3rd day, which the authors valued because they feared stiffness and circulatory problems more than the nonunion itself.
Treatment split roughly in thirds: nail only (28), plate only (40), and plate plus graft (30). Nailing was reserved for middle-third femur or tibia with normal axes.
Hospital stay was short and bone-dependent: clavicle 6.5 days, humerus/forearm 12 days, tibia 25 days, femur 32 days.

Board PearlRigid fixation, not scar excision, heals nonunion; graft only the avascular (inert) pseudarthrosis, never the hypervascular one.

Treatment of Nonunions by Compression

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Treatment of Nonunions by Compression

Müller·Clin Orthop Relat Res·1965·74 citations·Case series

|

Muller reports a 100-case series treating long-bone shaft nonunions with rigid internal fixation. Compression plating and intramedullary nailing are the two main methods, with grafting reserved for select cases. The paper defines when each technique and when a bone graft is indicated.

Key Findings

97 of 100 long-bone shaft nonunions united after a single operation with rigid internal fixation. All 3 failures were traced to a specific technical error, and every one of them united after revision with a nail.
The three failures teach the technical rules directly: a tibial plate placed on the medial (compression) side with varus, two plates across an inert femoral pseudarthrosis without a graft, and a nail that was too thin. Get these right and the construct works.
The Judet distinction drove graft decisions:
- Hypervascular ('elephant's foot') pseudarthrosis: viable, no graft needed.
- Avascular (inert bone ends): always needs a cancellous graft.
Interfragmentary compression increased plate stability by a factor of 1 to 10 and closed the fragment gap. In 30 ungrafted cases, ossification was faster than without compression.
No case needed plaster. Joints were mobilized on the 2nd or 3rd day, which the authors valued because they feared stiffness and circulatory problems more than the nonunion itself.
Treatment split roughly in thirds: nail only (28), plate only (40), and plate plus graft (30). Nailing was reserved for middle-third femur or tibia with normal axes.
Hospital stay was short and bone-dependent: clavicle 6.5 days, humerus/forearm 12 days, tibia 25 days, femur 32 days.

Board PearlRigid fixation, not scar excision, heals nonunion; graft only the avascular (inert) pseudarthrosis, never the hypervascular one.

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