![]() ![]() However, a recent much larger population-based study done in Scotland showed lower overall incidence than previously reported, at 1.9% in the adult population, with incidence of non-union for pelvis and femur fractures of, humerus of and tibia of incidence was seen to peak in the 25–44-year age group. A recent study from Australia on 853 patients showed overall 8% of patients who had fractures, being admitted to hospital per year for fracture healing complications. Incidence of non-union has been variably reported in the literature, depending on study size, patient demographics, injury location and severity and method of treatment, from anywhere between 2 and 30% with an estimated 100,000 episodes of fracture non-union per year in the USA. The presence or absence of infection is also important in terms of classification, which can further complicate the clinical picture and treatment modality. These definitions are based on the radiographic appearance of non-union. Well-vascularised fracture sites with abundant fracture haematoma but an unstable mechanical environment will usually develop ‘hypertrophic’ non-union, whereas impaired blood supply in combination with local strain concentration has been suggested to lead to ‘atrophic’ non-union. Instability at the fracture site in true non-union is often associated with ongoing pain, and as such, clinical signs are as important in diagnosis as the radiological examination. Others, however, have recommended that for long bones this should be revised to a period of 6 months if no evidence of radiological fracture healing is present. The US Federal Drug Administration council defines it as ‘failure to achieve union by 9 months since the injury, and for which there has been no signs of healing for 3 months’. Non-union has been defined in various ways, with a 55% disagreement amongst clinicians on timing. Moreover, it has shown itself to be particularly useful when planning surgical management of fracture non-union of both upper and lower extremities. Since its inception, the diamond concept has proven itself to be an important framework for understanding the minimal requirements for fracture healing. ![]()
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