Non union definition
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Non-Union - Definition
Non-union is a fracture complication where bony healing is no longer possible without operative intervention.
Definitions (from authoritative surgical texts)
Bailey and Love's Short Practice of Surgery (28th ed.) defines non-union as:
"A fracture that has not healed and shows no potential to heal without further intervention."
It can also be defined as a fracture that fails to demonstrate clinical or radiological improvement over 3 months. In practice, the term "non-union" is generally not applied until 6 months after the injury.
S. Das - Manual on Clinical Surgery (13th ed.) adds:
"Non-union means bony union of the fracture is not possible without operative intervention. The fragments are joined by fibrous tissue."
On X-ray, non-union shows sclerosis at the bone ends and a gap between them.
Types of Non-Union
| Type | Mechanism |
|---|---|
| Atrophic | Biological failure - lack of stimulus or blood supply; no callus formation |
| Hypertrophic | Excessive movement at the fracture site; abundant callus but no bridging |
| Infected | Infection prevents healing; wound often fails to heal with antibiotics alone |
Causes of Non-Union
- Infection at the fracture site
- Interposition of soft tissue (periosteum or muscle) between bone ends
- Inadequate blood supply (e.g., lower tibia fractures)
- Wide separation of fragments (e.g., patella, olecranon, or excessive traction)
- Inadequate treatment of delayed union (prolonged immobilization not maintained)
- Patient factors: diabetes, smoking, malnutrition
Key Distinction: Delayed Union vs. Non-Union
| Feature | Delayed Union | Non-Union |
|---|---|---|
| Definition | Fracture slow to heal beyond expected time | Fracture with NO potential to heal without surgery |
| Healing possible? | Yes, with conservative measures | No, requires operative intervention |
| X-ray | Progressive (slow) callus formation | Sclerotic bone ends, persistent gap |
| Fragments joined by | Soft callus (progressing) | Fibrous tissue |
Sources: Bailey and Love's Short Practice of Surgery 28th Ed.; S Das Manual on Clinical Surgery 13th Ed.
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