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When a fracture fails to union, the strategy for replacing the bone plate should be combined with the specific cause. Generally, measures such as changing the fixation method, increasing the stability of fixation, and eliminating infection can be considered. The following is a specific analysis:
Change the fixation method: If the fixation of the fracture site is unstable, it can be considered to change the fixation method. For example, if the original steel plate fixation effect is not good, it can be replaced with intramedullary nails, or a combination of both can be used for combined fixation. In some cases, simple replacement of coarse intramedullary nails combined with bone grafting may lead to a lower bone healing rate. The combined replacement of intramedullary nails and plate assistance combined with bone grafting is an effective way to achieve bone healing. However, this method has large trauma, long operation time and a large amount of bleeding, and a comprehensive preoperative assessment of the patient’s tolerance is required. Simple steel plate assistance combined with bone grafting treatment can also be chosen, which can achieve a better healing rate.
Enhancing fixation stability: Bone grafting can be used to increase the stability of the fracture site, thereby promoting fracture healing. Bone graft materials can be autologous bone, allogeneic bone or artificial bone. Autologous bone has good bone inductance and bone conduction, but it will increase the patient’s pain and surgical trauma. Allogeneic bone sources are relatively abundant, but there may be immune rejection reactions. Artificial bone avoids damage to the donor bone area, but its bone induction ability is relatively weak.
Eliminating infection: If there is infection at the fracture site, anti-infection treatment should be carried out promptly, such as using antibiotics, etc. After the infection is under control, the decision on whether to carry out bone plate replacement or other treatment measures will be made based on the specific situation. Infection can disrupt the microenvironment for fracture healing, affect the activity of osteoblasts, inhibit the formation of callus, and may also lead to bone resorption and necrosis, making fracture healing difficult. In severe cases, it can cause chronic osteomyelitis.