Considerazioni sul trattamento delle pseudoartrosi. Valutazione di diverse metodiche

In choosing the method of treatment of nonunions it is necessary to evaluate carefully the peculiar features of the lesion as well as the general conditions of the patient. As regards hypertrophic types, nonunion tissue is capable of biologic reaction and allows the use of internal or external fixation methods without exposure of the end of the fragments in most cases. Different conditions occur in atrophic nonunions, in which the biologic characteristics of the fragments require additional procedures beside stabilization. A direct exposure of the nonunion is needed in order to achieve an adequate contact between fragments and promote bone regeneration. At present intramedullary nailing, eventually locked, and external fixation are generally preferred to other methods for the surgical management of nonunions. The indications for compression plating with graft are now restricted to peculiar sites in which nonunions can not be treated otherwise.