Delayed union and nonunion

Status of bone
Classification
Classification
Classification
Classification
Pseudoarthrosis
Indication of operative treatment

 Status of bone

Classified based on location, infection, and etiology: 

Epiphyseal, metaphyseal, or diaphyseal

Septic or aseptic

Hypertrophic, oligotrophic, or atrophic

Pseudarthrosis


Classification

Classification

Classification

Classification

Pseudarthrosis

Properties of hypertrophic nonunion

Pseudomembrane containing fluid like an actual synovial joint

Sealed medullary canals 

Variable radiographic appearance

Bone scan reveals “cold cleft” 

TX : 

debridement of pseudoarthrosis

opening of the medullary canal

enhancement of stability (compression) 

bone grafting


Indications and Contraindications for Nonoperative and Operative Treatment

Indication for nonop. TX

Acceptable alignment 

Reasonable potential for healing

Time anticipated for healing is associated with little morbidity



Contraindication for nonop. TX 

Progressive fracture malalignment

Implant fail

Persistent excessive motion at nonunion site

Infection


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