Abstract:

Nonunions and delayed unions have been classically defined by Bassett as an arrest of the fracture healing process at an intermediary stage of repair, at which time the fracture gap is bridged by fibrocartilage. It is estimated that approximately 10-20 % oflong bone fractures in the United States will result in delayed unions when compared to the average rate of healing for the location and type of fracture. Many of these will go on to a nonunion if biological or biomechanical factors are not optimized to enhance healing. Additional commorbities such as smoking, ethanol abuse, malnutrition, malabsorption and altered neurologic conditions can contribute to delayed unions or norrun io ns.v" Even despite appropriate and aggressive early management of long bone fractures, a certain percentage still lack progression of healing and go on to nonunion. Classical surgical management of nonunions includes obtaininjr fracture stabilization with ORIF techniques and bone grafting, with reported clinical successes ranging from 50_80%. Those that fail to achieve union despite classical management are indeed recalcitrant nonunions.

Authors:

Joseph A. Longo, III, M.D.

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