Bone Nonunion

Excerpt

Nonunion of bone is the body's inability to heal a fracture. The most agreed-upon standard definition of nonunion made by the FDA is a fracture that persists for a minimum of nine months without signs of healing for three months. It bears mention that this is a loose definition and that not every bone behaves the same, and that the use of medicine like bisphosphonates can affect healing time. For example, a study by Aydogen et al. showed delayed unions (failure to reach union by six months) occur more frequently in atypical femur fractures, which are thought to be caused by long term bisphosphonate use. Furthermore, nonunion is a complex orthopedic problem that is multifactorial, and clinicians need to entertain multiple modalities as therapeutic interventions. One must review radiographs to determine if there is evidence of fracture healing demonstrated by cortical bridging of the fracture lines. Also, clinical markers of healing must be evaluated, evidenced by a resolution of pain with weight-bearing with no movement at the fracture site. Patient comorbidities require evaluation to determine the risk factor's for poor bone healing, and these factors must be optimized for fracture healing to occur.