Classification and management of nonunion of the humerus

Classification and management of tibial nonunion
definition: no evidence of healing over 3 months;
- FDA definition: frx that is over 9 months old and that has not shown radiographic signs of progression toward healing for 3 consecutive months;
- final stage of a nonunited fracture is formation of pseudoarthrosis;

Overview, classification and management of nonunion
frx of shaft of long bone should not be considered nonunion until at least 6 months post injury, esp treatment was complicated by infection;
- in contrast, a central fracture of the femoral neck can sometimes be defined as a non union after only 3 months;
- in established non union, sclerosis develops around the bone ends and medullary canals are sealed off;
- bone ends are joined by fibrous tissue;
- final stage of a nonunited fracture is formation of pseudoarthrosis

P. K. Beredjiklian, M.D., R. J. Naranja, M.D., R. B. Heppenstall, M.D., C. T. Brighton, M.D., Ph.D., and J. L. Esterhai, M.D.
Abstract: The purpose of this study is to report our experience with the treatment of femoral shaft fracture nonunion and to define poor prognostic indicators in the treatment of this complication. The records and available radiographs of 111 patients treated for nonunion of the femoral shaft in our institution were retrospectively reviewed. The mean duration of follow-up after establishment of nonunion was 62 months. The following factors were found to have an adverse effect on nonunion healing (p <0.05): (1) advanced patient age; (2) presence of osteomyelitis; (3) presence of synovial pseudarthrosis; (4) duration of nonunion; (5) treatment with flexible intramedullary devices; (6) treatment with compression plating; (7) poor bone stock; (8) malalignment in the anteroposterior plane of more than 10 degrees; and (9) malalignment in the lateral plane of more than 20 degrees. (Full Text article)

Wheeless Textbook of Orthopaedics Discussion: (see non union general discussion): - definition: no evidence of healing over 3 months; - FDA definition: frx that is over 9 months old and that has not shown radiographic signs of progression toward healing for three consecutive months;

eMedicine 2004 Patel
Synonyms and related keywords: tibial delayed union, aseptic nonunion, infected nonunion, tibial fractures, fractures of the tibia, nonunions of the tibia, broken leg, leg fracture, delayed healing, hypertrophic nonunions, atrophic nonunions, normotrophic nonunions, long bone fractures