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Definition and four causes of non-union of a fracture. Uh, answer from orthopedics point of view.

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fracture nonunion definition causes orthopedic reference

Non-union of a fracture is a fracture that has failed to unite and shows no further clinical or radiological progress toward healing, such that union is unlikely without additional intervention. In established non-union, the fracture ends are often connected by fibrous tissue rather than bone. The FDA time-based definition is persistence for at least 9 months with no healing progression for 3 months, but orthopaedically the diagnosis is primarily clinical and radiographic. NIH reference
Four common causes:
  1. Inadequate immobilization or unstable fixation
    Excessive movement at the fracture site prevents callus from bridging.
  2. Impaired blood supply
    Seen with severe soft-tissue stripping, open fractures, comminution, or fractures in areas with tenuous vascularity, such as the scaphoid neck or femoral neck.
  3. Infection
    Especially after open fractures or internal fixation. Infection causes bone necrosis and prevents osteogenesis.
  4. Gap at the fracture site / interposition of soft tissue
    Excessive distraction, bone loss, or muscle, periosteum, or other soft tissue caught between fragments prevents bony contact and union.
Textbook definition: Bailey and Love's Short Practice of Surgery, 28th ed., “Non-union” section.
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