Fracture nonunion is the cessation of a normal reparative process of fracture healing. With an incidence of 2.5%-4.4%, it is one of difficult problem for orthopedics surgeons. Definition, classification, treatment and causes of fracture nonunion are reviewed in this article. The therapeutic principles and methods are introduced systematically combined with causes of fracture nonunion.
Fracture Healing ; Fractures, Ununited ; diagnosis ; therapy ; Humans

Child ; Fractures, Ununited/surgery* ; Humans ; Postoperative Period

Old fracture generally refers to fractures for more than 3 weeks, and complications caused by delayed treatment or therapy: delayed union, malunion and nonunion of fractures. Delayed union means that fracture healing is not taking place within the expected time, but the definition of fracture nonunion is controversy. Delayed union and nonunion of fractures are caused by a variety of factors, unstable and blood supply of destroy are considered the most important factors. Because of substantial suffering about patients living, working and economics caused by delayed union and nonunion, early intervention is necessary. Treatment includes conservative and operative. Mechanical stimulation, physical treatment and bio-stimulation have been proven to promote healing of fractures, autogenous cancellous bone graft combined with strong fixation is the gold standard for surgery. Malunion means a consolidation of a fracture in a position of deformity and malalignment. Deformities are described in terms of abnormalities of length, angulation, rotation, and translation. The treatment of malunion is a lengthy and complex process and the main purpose is to relieve pain, restoring alignment and function.
Fracture Healing ; Fractures, Bone ; Fractures, Ununited ; Humans ; Time Factors

Fracture Fixation ; Fractures, Ununited ; surgery ; Humans ; Osteogenesis, Distraction

PURPOSE: To evaluate the factors affecting the bone union time and the occurrence of nonunion after intramedullary nailing of subtrochanteric femoral fractures in adults. MATERIALS AND METHODS: We retrospectively reviewed data from 31 patients (22 men and 9 women) who had undergone femoral intramedullary nailing at least 1 year post-operatively and analyzed the bone union time, nonunion rates, and factors that affected the bone union time according to the fracture classification (AO and Fielding classifications), comminution of the medial cortex, reduction method, and additional cerclage wiring. RESULTS: The average union time was 26.4 weeks. There were no differences in the bone union time according to the fracture classification, reduction method, or additional cerclage wiring. Significant differences were found in the bone union time between the medial cortex comminution and non-comminution groups. A relatively strong positive correlation was detected between the degree of post-operative displacement and the bone union time. Nonunion occurred in three cases and there was no failure of implants. CONCLUSION: The bone union time was not affected by the reduction method nor additional cerclage wiring in intramedullary nailing of subtrochanteric femur fractures. Comminution of the medial cortex and the degree of the postoperative displacement of fractures contributed to the delayed time of union.
Adult ; Classification ; Femoral Fractures ; Femur ; Fracture Fixation, Intramedullary ; Fractures, Ununited ; Hip Fractures* ; Humans ; Male ; Retrospective Studies

OBJECTIVETo explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening.

METHODSTwenty patients (13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients.

RESULTSAll the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months.

CONCLUSIONSBoth the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

Adolescent ; Adult ; Bone Transplantation ; methods ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation ; methods ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Pseudarthrosis ; surgery ; Tibia ; pathology ; surgery ; Tibial Fractures ; surgery ; Transplantation, Homologous ; Treatment Outcome

Difficult femoral nonunion takes account of infective nonunion and aseptic gap nonunion. Limb length discrepancy and nonunion need to be tackled simultaneously. Conventionally Ilizarov ring fixator is in vogue but it has some limitations. To overcome these, monorail fixator is an effective alternative. Persistent good results can be obtained if we can get a perfect anatomical alignment and good regeneration.
External Fixators ; Femoral Fractures ; surgery ; Fracture Fixation ; instrumentation ; Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique

Fractures of the paediatric talus are infrequent injuries, most complicated by posttraumatic arthrosis and avascular necrosis in the course of treatment. Nonunion in children has not been reported before in literature. We report a case of a 12-year-old boy who had a nonunion of Hawkins type II fracture of talar neck. The nonunion was treated surgically with a good clinical outcome. The goals of management in nonunion of paediatric talar neck fracture are different from those in fresh fractures. A suboptimal reduction should be acceptable without trying a radical surgery which may cause further impairment.
Child ; Fractures, Bone ; surgery ; Fractures, Ununited ; surgery ; Humans ; Male ; Talus ; injuries

Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Tibial Fractures ; surgery

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.
Adolescent ; Adult ; Female ; Femoral Fractures ; surgery ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies