caa a22 4500 469114886 CHVBK 20180323133122.0 cr unu---uuuuu 170328e19920201xx s 000 0 eng 10.1007/BF00443475 doi (NATIONALLICENCE)springer-10.1007/BF00443475 Refractures: a consequence of impaired local bone viability [Elektronische Daten] [S. Kessler, S. Deiler, Marianne Schiffl-Deiler, H. Uhthoff, L. Schweiberer] Summary: Bone necrosis secondary to avascularity may not only delay or inhibit consolidation of a fracture, it may also be a cause of refracture. Both initial trauma und surgical insult will determine the extent of necrosis. Only the latter is under the surgeon's control; it can be reduced by gentle soft tissue handling and by minimizing periosteal stripping. While the impact of avascular necrosis on fracture healing is well recognized, its role in the pathogenesis of refractures has received less attention. Cortical necrosis delays bridging of gaps; these gaps act as stress risers which, following resumption of full activity or after implant removal, can lead to refracture. Evaluation of 28 refractures in 25 patients, with biopsies in 14 patients, suggests that the duration of fracture immobilization through external or internal means must be sufficiently long to allow vascular invasion of necrotic areas, their substitution by new bone and bridging of the fracture. These processes must be followed by radiographic studies prior to implant removal. Special attention needs to be paid to adequate visualization of the fracture gap on successive radiographs. Springer-Verlag, 1992 Kessler S. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut Deiler S. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut Schiffl-Deiler Marianne Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut Uhthoff H. Division of Orthopaedic Surgery, Ottawa General Hospital, 501 Smyth Road, KIH 8L6, Ottawa, Ontario, Canada aut Schweiberer L. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut Archives of Orthopaedic and Trauma Surgery Springer-Verlag 111/2(1992-02-01), 96-101 0936-8051 111:2<96 1992 111 402 https://doi.org/10.1007/BF00443475 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00443475 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kessler S. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut NATIONALLICENCE 700 1- Deiler S. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut NATIONALLICENCE 700 1- Schiffl-Deiler Marianne Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut NATIONALLICENCE 700 1- Uhthoff H. Division of Orthopaedic Surgery, Ottawa General Hospital, 501 Smyth Road, KIH 8L6, Ottawa, Ontario, Canada aut NATIONALLICENCE 700 1- Schweiberer L. Chirurgische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Nußbaumstrasse 20, W-8000, München, Germany aut NATIONALLICENCE 773 0- Archives of Orthopaedic and Trauma Surgery Springer-Verlag 111/2(1992-02-01), 96-101 0936-8051 111:2<96 1992 111 402 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer