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Nonunion is a medical condition where a broken bone fails to heal properly without intervention, such as surgery. It’s often described as forming a structure […]

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Nonunion is a medical condition where a broken bone fails to heal properly without intervention, such as surgery. It’s often described as forming a structure similar to a fibrous joint, leading to it sometimes being called a “false joint” or pseudoarthrosis. Nonunion typically becomes a concern when there’s no sign of healing between two sets of medical images (like X-rays or CT scans) after 6–8 months.

Signs and Symptoms

Patients with nonunion usually have a history of a bone fracture accompanied by persistent pain at the fracture site, and possibly abnormal movement or a clicking sound at the level of the fracture.


Nonunion can result from several factors, including avascular necrosis (disrupted blood supply due to the fracture), misalignment of the fracture ends, infection (notably osteomyelitis), movement at the fracture site, or soft-tissue imposition.

Risk Factors

Risk factors for nonunion include old age, poor nutrition, nicotine and alcohol use, metabolic disturbances, and genetic predisposition. The site of the fracture, the presence of infection, and the quality of initial treatment can also influence the risk.

Types of Nonunion

  1. Hypertrophic Nonunion: Adequate blood supply is present, but the bone ends fail to join due to instability. Treatment typically involves increasing the stability of the fracture site.

  2. Atrophic Nonunion: Characterized by little to no callus formation, usually due to poor bony healing. Treatment may involve stimulating blood flow and encouraging healing through surgical means.

  3. Oligotrophic Nonunion: Indicates some healing attempt by the body but is affected by displacement at the fracture site.


Diagnosis of nonunion is determined when no further bone healing is expected without intervention. Advanced imaging techniques and blood tests can assist in the evaluation.


Treatment for nonunion often involves surgery, including debridement, immobilization, and possibly bone grafting. Bone stimulation using electromagnetic or ultrasound waves has also been suggested as a treatment approach, though evidence of its effectiveness is weak.


Without intervention, a nonunion will not heal, leaving the patient with symptoms and impaired function. However, with treatment, the prognosis improves, with around 80% of nonunions healing after the first operation.

Nonunion (Wikipedia)

Nonunion is permanent failure of healing following a broken bone unless intervention (such as surgery) is performed. A fracture with nonunion generally forms a structural resemblance to a fibrous joint, and is therefore often called a "false joint" or pseudoarthrosis (from Greek pseudo-, meaning false, and arthrosis, meaning joint). The diagnosis is generally made when there is no healing between two sets of medical imaging, such as X-ray or CT scan. This is generally after 6–8 months.

Hypertrophic nonunion of the tibia

Nonunion is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected. Patients who smoke have a higher incidence of nonunion. The normal process of bone healing is interrupted or stalled.[citation needed]

Since the process of bone healing is quite variable, a nonunion may go on to heal without intervention in very few cases. In general, if a nonunion is still evident at 6 months post-injury it will remain unhealed without specific treatment, usually orthopedic surgery. A non-union which does go on to heal is called a delayed union.

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