HOT TOPIC: Update on the Management of Nonunion

Abstract

A fracture nonunion represents a disturbance of the bone healing process. Nonsurgical treatment options for nonunion include nutritional enhancements, bracing, correction of endocrinopathy or metabolic disorder, and electromagnetic and ultrasonic bone stimulation. Surgical options include internal fixation, bone grafting, osteotomy, and distraction osteogenesis/bone transport. Amputation may also be considered for recalcitrant nonunions that have failed multiple operations designed to heal the bone, and are surrounded by a deficient soft-tissue envelope. Appropriate treatment is based on the type of nonunion and its anatomic location, because that will aid in the analysis of why the bone failed to heal and what it may need to achieve union. This article is an update on a previously published OKO topic on nonunion, with particular focus on diagnostic and nonsurgical therapeutic interventions and some new developments in surgical management.

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