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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(06): 1045-1050
DOI: 10.1055/s-0042-1746180
Artigo Original
Asami

Is Atrophic Nonunion a Misnomer – A Hospital-based Prospective Cross-Sectional Study

Article in several languages: português | English
Sandeep Kumar Chaudhari 
1   Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
,
Mohit Dhingra 
1   Departamento de Ortopedia, All India Institute of Medical Sciences, Rishikesh, Índia
,
Prashant Joshi 
2   Departmento de Patologia, All India Institute of Medical Sciences, Rishikesh, Índia
› Author Affiliations Financial Support No funding was received from any agency for the present study.
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Abstract

Objective The present study was conducted to estimate histologically the proportion of avascularity of fracture ends in case of nonunion of long bones.

Methods A total of 15 cases of established quiescent nonunion were operated according to the standard protocol and the fracture ends were evaluated histologically. The biopsied tissue was briefly fixed with formalin, embedded with paraffin (FFPE), and 5-micron sections were stained with hematoxylin and eosin according to standard protocols. Immunohistochemistry with anti-CD31 antibody (JC70A clone, DBS) was performed manually using standard protocols.

Results All cases of quiescent nonunion were included; radiologically, 2 cases were oligotrophic, and 13 cases were of atrophic nonunion. A total of 20% of the patients were females, 40% were in the age group between 31and 40 years old, and, radiologically, all cases were of atrophic nonunion. All cases showed positivity for CD-31 on immunohistochemistry. The blood vessel density was category I in 13.33% of the cases and category II in 86.67% of the cases. Four cases presented with mild inflammation and two presented with moderate inflammation. The average vessel count was 10 per high power field in the age groups between 20 and 30, 31 and 40, and 41and 50 years old. The age group between 61 and 70 years old showed an average vessel count of 4 per high power field. The difference in the vessel counts of oligotrophic and atrophic nonunion was not significant. No correlation was observed in the density of vessel count and duration of nonunion

Conclusion The nomenclature for the classification of nonunion into atrophic, oligotrophic, and hypertrophic needs revision. Our findings do not support that atrophic and oligotrophic nonunion are histologically different.

Keywords

fractures, ununited - fractures, bone - antigen, CD31

The present work was developed at the Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India




Publication History

Received: 21 December 2021

Accepted: 18 February 2022

Article published online:
06 July 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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