Objectives: To delineate the contributing factors of diaphyseal fracture nonunion in children and to determine suggested treatment based on the cohort examined.
Design: Retrospective review.
Patients: 16 children who underwent operative treatment for diaphyseal nonunion from January 1995 to December 2009.
Intervention: Stabilization by internal or external fixators with or without bone grafting.
Main outcome measure: Clinical reviews were evaluated by the side of the injury, mechanism of injury, time interval between injury and surgery, operation time, initial treatment type, and nonunion treatment type, and demographic date including age, sex, the presence or absence of pediatric diabetes, and follow-up duration. Radiographic evaluations were obtained to confirm the fracture site and the classification of the fracture pattern preoperatively, and they were used to postoperatively detect the type of nonunion, the time interval between the treatment of nonunion to bony union, and the residual deformity.
Results: The youngest patient was 6 years with the average age being 11.1 years. Only one of the patients was younger than 8 years, so the distribution was a closed interval beginning at this age. Regardless of age, 16 of the patients were likely to experience nonunion if high-energy traumas and iatrogenic soft tissue injuries caused by the open-reduction procedure were abundant at the time of the fractures.
Conclusions: The frequency of occurrence was affected by the age of the patient, and it increased when there was extensive iatrogenic soft tissue or insufficient fixation at the time of fracture. Close attention should be paid when dealing with nonunion so that iatrogenic damage is not caused, and sufficient fixation should be performed with adequate tools. Also, it should be noted that it is not unusual for deformities to occur and correction for such deformities should also be considered at the time of surgery.
Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.