Non-union of Tibia
Definition • Classification • Causes • Management Strategies
DNB Orthopaedics • May 2024 • Paper IV • 10 Marks
Introduction
The tibial shaft is one of the commonest sites of fracture non-union. This is related to its subcutaneous location, relatively vulnerable soft-tissue envelope, frequency of high-energy open injuries and segmental bone loss.
Tibial non-union should not be regarded simply as a failure of bone formation. It is usually the result of failure of one or more of the essential requirements for union: mechanical stability, biological viability, absence/control of infection and adequate alignment/contact.
The central management principle is: identify why the fracture has failed to unite and correct that specific deficiency.
1. Definition
Non-union is failure of a fracture to demonstrate progressive healing within the expected period such that union is unlikely to occur without further intervention.
Classical regulatory definition:
A fracture persisting for approximately 9 months with no radiographic progression of healing for the preceding 3 months has historically been used as an objective definition of non-union.
However, in clinical orthopaedics, treatment should not be delayed merely to satisfy a time criterion when the fracture pattern, serial radiographs and biology clearly indicate that spontaneous union is…