Michael Grunert1,2, Carsten Hackenbroch3,4, Falk von Lübken5. 1. Klinik für Nuklearmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland. 2. Klinik für Nuklearmedizin, Universitätsklinikum Ulm, Ulm, Deutschland. 3. Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland. 4. Klinik für Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland. 5. Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland. falkvonluebken@bundeswehr.org.
Abstract
BACKGROUND: Fracture healing is a complex regenerative process. An unconsolidated fracture that will not heal without further surgical intervention is called non-union. The causes are multifactorial. Diagnostic imaging is a central pillar and provides insights into the morphology and biology of the fracture as a basis for optimal surgical treatment decisions. AIM: Knowledge of fracture healing, targeted radiological and nuclear medical diagnostics, and interdisciplinary standardized classification are of high importance for optimal treatment. METHODS: In this article, the proven and modern diagnostic procedures are presented, an overview of the currently used scoring and classification models is given and the optimal therapeutic approach based on the extended "diamond concept" is addressed. A possible diagnostic and therapeutic approach is shown using an algorithm. CONCLUSION: For successful treatment of pseudarthrosis, targeted radiological and nuclear medical diagnostics with old established but also newest methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and hybrid imaging, are necessary. An exact classification of non-unions using additional classification models makes it possible to determine and carry out the optimal surgical treatment at an early stage.
BACKGROUND: Fracture healing is a complex regenerative process. An unconsolidated fracture that will not heal without further surgical intervention is called non-union. The causes are multifactorial. Diagnostic imaging is a central pillar and provides insights into the morphology and biology of the fracture as a basis for optimal surgical treatment decisions. AIM: Knowledge of fracture healing, targeted radiological and nuclear medical diagnostics, and interdisciplinary standardized classification are of high importance for optimal treatment. METHODS: In this article, the proven and modern diagnostic procedures are presented, an overview of the currently used scoring and classification models is given and the optimal therapeutic approach based on the extended "diamond concept" is addressed. A possible diagnostic and therapeutic approach is shown using an algorithm. CONCLUSION: For successful treatment of pseudarthrosis, targeted radiological and nuclear medical diagnostics with old established but also newest methods, such as dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and hybrid imaging, are necessary. An exact classification of non-unions using additional classification models makes it possible to determine and carry out the optimal surgical treatment at an early stage.
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