Fracture non-union describes the failure of normal fracture healing processes. Solid bone healing will not occur without further treatment or intervention.
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Terminology
There is no consensus definition in the radiology or orthopedic literature, however, FDA (USA) defines it as a fracture with a minimum of at least nine months since the initial injury with no signs of healing for the final three months 1.
Radiographic features
There are different types of fracture non-union with various imaging characteristics:
- hypertrophic: abundant callus formation; radiolucent line (unmineralized fibrocartilage) at the non-union site
- oligotrophic: little or no callus formation; diastasis at the fracture site
- atrophic: bony surfaces partially resorbed; no callus formation; osteopenia; sclerotic avascular bone segments; segmental bone loss
- infected: osteolysis; osteopenia; sclerotic avascular bone segments; segmental bone loss
- synovial pseudoarthrosis: variable appearance (hypertrophic, oligotrophic, or atrophic)