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Fracture non-union; what are the current perceived challenges among clinicians?

  • Author Footnotes
    1 Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds.
    Harry Hodgson
    Footnotes
    1 Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds.
    Affiliations
    Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom
    Search for articles by this author
  • Author Footnotes
    2 LIRMM, University of Leeds, Leeds.
    Peter V Giannoudis
    Correspondence
    Corresponding author at: Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, LS1 3EX, Leeds, UK.
    Footnotes
    2 LIRMM, University of Leeds, Leeds.
    Affiliations
    Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

    NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
    Search for articles by this author
  • Author Footnotes
    3 LIRMM, University of Leeds, Leeds/NDORMS, Oxford University.
    Anthony Howard
    Footnotes
    3 LIRMM, University of Leeds, Leeds/NDORMS, Oxford University.
    Affiliations
    Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, United Kingdom

    NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
    Search for articles by this author
  • Author Footnotes
    1 Leeds Orthopaedic Trauma Sciences, Leeds University, Leeds.
    2 LIRMM, University of Leeds, Leeds.
    3 LIRMM, University of Leeds, Leeds/NDORMS, Oxford University.
Published:November 01, 2022DOI:https://doi.org/10.1016/j.injury.2022.10.029
      Non-union is the failure of a fracture to unite in a timely fashion with an incidence reported to range from 2%-10% [
      • Mills LA
      • Aitken SA
      • Simpson AHRW.
      The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults.
      ]. The aetiology is often multifactorial, involving a complex interplay relating to the biological pre-requisites and mechanical environment, as well as the physiological state of the host [
      • Giannoudis PV
      • Einhorn TA
      • Marsh D.
      Fracture healing: the diamond concept.
      ]. It is believed that the evolution of fracture healing involves the participation and optimum interaction of the key players (growth factors, stem cells, osteoconductive scaffolds and adequate mechanical environment) according to the ‘diamond concept’ [
      • Giannoudis PV
      • Einhorn TA
      • Marsh D.
      Fracture healing: the diamond concept.
      ]. There is a lack of current clinical treatment guidance on the topic, as well as varying definitions of non-union which further adds to the challenge of managing non-union.

      Keywords

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