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From the American Academy of Orthopaedic Surgeons

Nonunion

by Jeffrey O. Anglen, MD

Nonunion has classically been defined as the cessation of all bone healing processes. Practically, nonunion has been considered when a fracture has failed to unite after some time period, six months being chosen most often. The specific constellation of factors and influences that causes a failure of healing is unique to the individual case. The etiology of nonuion is often multifactorial. The incidence of nonunion varies tremendously by fracture site. Even for common fractures, some sites, such as the femoral neck, have a very high incidence of nonunion, while others, such as the distal radius, have a very low incidence. The treatment options for long bone nonunion can be divided into surgical and nonsurgical.

This article reviews the pathophysiology and clinical presentation of nonunion and presents management options, including nonsurgical and surgical. Specific surgical techniques reviewed in detail include intertrochanteric osteotomy for nonunion of the femoral neck and posterolateral bone graft for tibial nonunion. Video is available. CME credit is available.

Keywords: etiology, incidence, classification, risk factors, diagnosis, patient history, physical examination, imaging, radiography, measurement of cortical continuity, tomography, bone scanning, scintigraphy, MRI, differential diagnosis, management, nonsurgical treatment, surgical treatment, surgical techniques, femoral neck fracture nonunion, intertrochanteric osteotomy, tibial shaft fracture nonunion, posterolateral bone graft, indications, contraindications, complications, outcomes, rehabilitation

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