RECALCITRANT NONUNION

One surgeon treated 13 patients with 14 long bone fractures that remai ned ununited for 10 or more years (average, 16 years) and after an ave rage of three prior surgeries, The clavicle was involved in two cases, the humerus in five (one proximal, three diaphyseal, and one distal i ntraarticular), the femoral diaphysis in three, and the tibial diaphys is in four, The patients were observed for an average of 54 months, Al l of the fractures healed, and every patient in the series regained fu nctional use of the involved limb without reports of pain, instability , or persistent swelling related to the site of nonunion, Three patien ts had persistent leg length discrepancies, and five had substantial r esidual stiffness of one or both adjacent joints, This experience has shown that despite the longevity of the nonunions, healing can be achi eved using the basic concepts of the creation of a stable skeletal fix ation in the presence of a well vascularized environment with the addi tion of autogenous bone graft, By the same token, the duration of the nonunion will lead to soft tissue maladaptation and contracture that a t times compromise successful restoration of limb length or adjacent a rticular mobility.