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Review
. 2021 Aug 5;7(1):57.
doi: 10.1038/s41572-021-00289-8.

Non-union bone fractures

Britt Wildemann  1   2 , Anita Ignatius  3 , Frankie Leung  4 , Lisa A Taitsman  5 , R Malcolm Smith  6 , Rodrigo Pesántez  7 , Martin J Stoddart  8 , R Geoff Richards  8 , Jesse B Jupiter  9
Affiliations
Review

Non-union bone fractures

Britt Wildemann et al. Nat Rev Dis Primers. .

Abstract

The human skeleton has remarkable regenerative properties, being one of the few structures in the body that can heal by recreating its normal cellular composition, orientation and mechanical strength. When the healing process of a fractured bone fails owing to inadequate immobilization, failed surgical intervention, insufficient biological response or infection, the outcome after a prolonged period of no healing is defined as non-union. Non-union represents a chronic medical condition not only affecting function but also potentially impacting the individual's psychosocial and economic well-being. This Primer provides the reader with an in-depth understanding of our contemporary knowledge regarding the important features to be considered when faced with non-union. The normal mechanisms involved in bone healing and the factors that disrupt the normal signalling mechanisms are addressed. Epidemiological considerations and advances in the diagnosis and surgical therapy of non-union are highlighted and the need for greater efforts in basic, translational and clinical research are identified.

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References

    1. Brinker, M. R., Hanus, B. D., Sen, M. & O’Connor, D. P. The devastating effects of tibial nonunion on health-related quality of life. J. Bone Joint Surg. Am. 95, 2170–2176 (2013).
    1. Brinker, M. R., Trivedi, A. & O’Connor, D. P. Debilitating effects of femoral nonunion on health-related quality of life. J. Orthop. Trauma 31, e37–e42 (2017). A cohort study looking at femoral non-union, the impact of this disease is similar to end-stage hip arthrosis and tibial non-union, and worse than other medical conditions.
    1. Mills, L. A., Aitken, S. A. & Simpson, A. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults. Acta Orthop. 88, 434–439 (2017). This paper showed that the analysis of non-union incidence revealed the overall peak incidence at an age between 30 and 40 years, with more frequent non-unions in upper limbs than in lower limbs. - PubMed - PMC
    1. Zura, R. et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 151, e162775 (2016). This paper is a large cohort study identifying patient-specific risk factors for the development of non-union.
    1. Taylor, J. C. in Campbell’s Operative Orthopaedics (eds Crenshaw, A. H., Daugherty, K. & Campbell, W. C.) 1287–1345 (Mosby, 1992).

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