Recent therapeutic concept categorizes the nonunion of long bone fractures into three types according to the osteogenic potential of fractured bone ends. In the first type the bone ends no longer have osteogenic power, in the second one the bone
ends
have only limited power to unite, and in the one unstable internal or external fixation does not allow bone union even though the bone ends have excellent ability to unite. Each type of nonunion can be managed by removal of the nonosteogenic
sites,
bone
grafts, and stable fixations respectively. We applied the concept to the analysis of 85 cases of the noununion of the lower limb long bones, which were experienced at Seoul Paik Hospital from January 1986 to December 1991, to elucidate the causal
relationship of the nonunion with types of injury, morphological features of fracture, types of instrument used, vascularity of fracture sites and other possible etiologic factors. The results of the analysis showed that the high energy injury,
open and
comminuted fracture, hypovascularity, and instrumentation with plate the screws were strongly injuy, open and comminuted fracture, hypovascularity, and instrumentation with plate and screws were strongly associated with the nonunion. Metal
failures
were
usually caused by the avascular nonunion and the plates were usually broken through the empty hole near fracture site. The results suggested that 1) intramedullary nailing is preferable to plating for the treatment of long bone shaft fracture, 2)
caution should be paid to ensure adequate blood circulation when plate is used, 3) bone graft should be performed immediately when avascular bone fragments of gap exist, 4) close proximities of bone ends should be maintained when there are no
comminuted
bone fragments.
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