adult patient with fracture shaft ulna 6 months ago and treated with closed reduction and cast now there is sill pain in the fracture site and x-ray show hypertrophic nonunion treated by:
- a. continue on the cast
- b. fixation by plate without bone graft
- c. fixation with plate and iliac crest bone graft
- d. closed reduction and interlocking nail.
The most appropriate treatment for an adult patient with a hypertrophic nonunion of the ulnar shaft fracture 6 months after closed reduction and casting is: c. Fixation with plate and iliac crest bone graft.
Here's why:
- Hypertrophic nonunion:
This indicates that the bone fragments haven't healed properly, despite the initial treatment. The excessive bone formation around the fracture site is a sign of failed healing.
- 6 months:
This is a sufficient timeframe for a fracture to heal in most cases. After 6 months without proper healing, surgical intervention is usually necessary.
- Closed reduction and cast:
These are not effective treatment options for a nonunion. They were already used in the initial treatment and failed to achieve proper healing.
- Fixation with plate:
This provides stability and helps to realign the bone fragments. However, in cases of nonunion, bone grafting is often necessary to stimulate bone growth and bridge the gap between the fragments.
- Iliac crest bone graft:
This is a common source of bone graft for fractures. It provides healthy bone tissue to promote healing in the nonunion site.
Therefore, option c addresses the specific challenges of a hypertrophic nonunion and provides the best chance for successful healing.
