State of the Nonunion: A review of the latest literature
Wendy Ghanem, Hady Ezzeddine, Rita Saad, Elyssa Kiwan, Raymonde Dahdouh, Omar Al Fakih, Georges Sakhat, Elie Alam, Joseph Najjar, Fouad Assaf, Moro Chahine, Nabil Dib, Rabih Kortbawi, Mohammad Badra, Ramzi Moucharafieh
Abstract
The distinction between prolonged bone healing and nonunion in long bone fracture remains a historical challenge in the field of orthopedics. Despite numerous proposed definitions and scoring systems, a consensus remains elusive, thereby complicating both diagnosis and treatment. An accurate diagnosis is necessary, facilitated by a range of imaging modalities. Bone nonunion management encompasses surgical and non-surgical options, including external or internal fixation, and bone grafting, tailored to the nonunion type. This review discusses the pathophysiology of nonunion, risk factors, diagnosis and treatment. It particularly addresses early detection and the impacts of nonunion on the patient. The aim of this review is to obtain a global and updated point of view regarding nonunion of the bone as well as to reflect on the potential use of untraditional methods in their treatment such as orthobiologics, along with emerging and non-invasive technologies including shockwave therapy, gene therapy, tissue engineering, regenerative medicine and 3D printing.