Fracture Nonunion: Clinical Insights and Innovations

In the last twenty years, there has been a significant increase in the incidence of fractures, primarily due to population growth and aging. In 2019 alone, 178 million fractures were reported globally (1). Consequently the incidence of complications, such as fracture non-union (FNU), increased in parallel (2). The rate of fracture non-union is estimated to range between 2 and 10%, and depends largely on the severity of the injury, the anatomical localization of the fracture, disease comorbidities and medication use (3, 4). The treatment of this serious complication continues to pose a significant challenge to even the most experienced orthopaedic trauma surgeons. Although the management of this complication has improved over the past decades many open questions remain. In daily clinical practice, for example, it remains unclear what the most optimal diagnostic strategy and definition of fracture non-union are. This lack of a clear, universal definition emphasizes the need for a consensus-based approach to the diagnosis of fracture non-union centered on clinical, radiographical and time-related criteria. Thereafter, and as shown for fracture-related infection, treatment pathways need to be standardized on a global scale. Fortunately, today, collaborative efforts between interdisciplinary teams, including physicians and researchers, are fostering the development of innovative management strategies that should improve patient care in the long term.