Non-union: Indications for external fixation

• Published in: Injury Vol. 50; pp. S73 - S78
• Main Authors: Simpson, A.H.R.W., Robiati, L., Jalal, M.M.K., Tsang, S.T.J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2019
• Subjects: Delayed union; External fixation; External Fixators; Fracture Fixation, Internal - adverse effects; Fracture Healing - physiology; Fracture non-union; Fracture-related infection; Fractures, Bone - pathology; Fractures, Bone - surgery; Fractures, Ununited - pathology; Fractures, Ununited - surgery; Humans; Reoperation; Surgical Wound Infection - surgery; External fixation; Delayed union; Fracture-related infection; Fracture non-union
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.03.053

•This review provides a comprehensive overview for the indications of external fixation in fracture non-union.•It is imperative to distinguish between delayed union and non-union, especially in fractures healing by primary bone repair.•The indications for external fixation are being refined with greater understanding of outcomes. External fixation is currently used as the definitive mode of fracture stabilisation in the management of ˜50% of long-bone non-unions. Distinction between non-union and delayed union is a diagnostic dilemma especially in fractures healing by primary bone repair. This distinction is important, as non-unions are not necessarily part of the same spectrum as delayed unions. The aetiology of a fracture non-union is usually multifactorial and the factors can be broadly categorized into mechanical factors, biological (local and systemic) factors, and infection. Infection is present in ˜40% of fracture non-unions, often after open fractures or impaired wound healing, but in 5% of all non-unions infection is present without any clinical or serological suspicion. General indications for external fixation include clinical scenarios where; 1) percutaneous correction of alignment, or mechanical stimulation of the non-union site is required; 2) fixation of juxta-articular or ‘emmental’ bone fragments is necessary; and 3) staged bone or soft tissue reconstruction is anticipated. Specific anatomical indications include infected non-unions of the tibia, humerus, and juxta-articular bone. External fixation is an essential tool in the management of fracture non-unions. However, with greater understanding of the outcomes associated with both external and internal fixation the relative indications are now being refined.