Aseptic nonunion.

Nonunion is defined as the failure of a fracture to heal in twice the usual period of time (at least 9 months after trauma); the fracture gap is bridged by fibrous tissue or fibrocartilage instead of bone tissue. The main clinical signs are abnormal mobility with or without local tenderness. Radiographic signs include persistence of fracture line, sclerosis of bone ends, hypertrophic callus formation or atrophic bone resorption, and possibly, radiolucency around osteosynthetic devices. Decision-making is important in treating any type of nonunion. The first and most important step is to rule out infection and decide whether septic or aseptic nonunion and atrophic or hypertrophic variety. Next step is to differentiate whether it is stiff or mobile nonunion by clinically. Associated problems are to be identified, including adjacent joint involvement, presence of bone gap, stability at the fracture or fixation site, and presence of limb-length discrepancy. Hence, the treatment needs to be individualized. Several options are available, including plates, nails, and external fixators. Ring fixator is more versatile in managing these conditions as they allow early weight-bearing and allow simultaneous correction of limb-length discrepancy and deformity. [ABSTRACT FROM AUTHOR]