Fracture Non-Unions and Mal-Unions

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The majority of fractures treated with or without an operation heal in a satisfactory position. Satisfactory fracture healing is dependent on many factors and the initial treatment decisions are very important.

Factors relating to the anatomical location, fracture pattern and displacement need to be considered. Individual patient factors are also very important. Unfortunately, despite optimum treatment some fractures will not heal satisfactorily.

If a fracture does not heal within an expected period of time, but heals with further time, it is described as a delayed union. A degree of judgement is required to differentiate a potential delayed union from a non-union. A non-union describes a fracture that is observed to have stopped showing signs of progress and will not heal without further intervention. Mal-union occurs when a bone heals in an unsatisfactory position and is likely to cause immediate functional limitations or pre-dispose to long-term disability.

Under any of these circumstances it is essential that a detailed clinical assessment is performed in conjunction with further investigations. There are many treatment options that can be considered and choosing the best strategy is dependent on optimising all factors under the control of the patient and surgeon before, during and after the chosen intervention. Co-ordinated involvement of a multi-disciplinary team is a key element of success.

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