Nonunion 733.82

Bone Stimulators

EBI Bone Stimulators

Exogen bone healing system

DONJOY bone stimulators

Orthofix bone stimulator

• synonyms:
• ICD-9=733.82(nonunion of fracture)
• Nonunion = no improvement clinically or radiologically in fracture healing over a 3 month period.

Nonunion Risk Factors

• Open fractrue
• tobacco use
• Diabetes
• Malnutrition
• Increased age

Nonunion Treatment

• Consider evaluation for underlying metabolic disturbances (Brinker MR, JOT 2007;21:557)
• Bone growth stimulators: Non-invasive electrical bone growth stimulation is considered medically appropriate when all of the following criteria are met:
  -At least three (3) months have passed since the date of fracture; and
  -Serial radiographs have confirmed that no progressive signs of healing have occurred; and
  -The fracture gap is one (1) cm or less; and
  -The individual can be adequately immobilized and is likely to comply with non-weight bearing.

Specific Nonunions

• Humeral Shaft Nonunion
• Tibial Shaft Nonunion

Fusion / Nonunion Clinical Utility

• Amplify rhBMP-2 Matrix; Medronic: slown to decrease operative time, and blood loss and increase fusion rates compared to iliac crest graft for lumbar fusion (Dimar J, JBJS 2009;91A:1377).