A number of risk factors may be associated with non-union of a fracture. A patient with one or more of these risk factors may benefit from more aggressive or alternative management.
Risk factors for fracture non-union:
(1) high-energy injury
(2) comminution
(3) displacement
(4) open fracture
(5) fracture site motion (nonfixation)
(6) gap in bone
(7) poor blood supply
(8) infection
(9) extensive soft tissue damage
(10) surgical interventions that jeopardize blood supply (stripping of periosteum for plating, damage to endosteum by nailing)
Note: The classification of Nicoll for non-union of fractures of the tibial shaft is discussed in 29.42.04.
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