This case series from a tertiary nonunion referral center asks whether patients with unexplained nonunions, multiple low-energy fractures ending in nonunion, or nondisplaced pelvic stress fracture nonunions harbor previously undiagnosed metabolic or endocrine disease. Thirty-seven patients meeting defined screening criteria underwent formal endocrinology evaluation to find out.
When you encounter a nonunion despite technically adequate fixation, a history of multiple low-energy fractures, or a nonunion of a nondisplaced pubic rami or sacral ala fracture, refer to endocrinology before assuming the problem is purely mechanical — more than 4 in 5 such patients will have an undiagnosed metabolic or endocrine disorder, most commonly vitamin D deficiency, that may be silently preventing healing.
This case series from a tertiary nonunion referral center asks whether patients with unexplained nonunions, multiple low-energy fractures ending in nonunion, or nondisplaced pelvic stress fracture nonunions harbor previously undiagnosed metabolic or endocrine disease. Thirty-seven patients meeting defined screening criteria underwent formal endocrinology evaluation to find out.
When you encounter a nonunion despite technically adequate fixation, a history of multiple low-energy fractures, or a nonunion of a nondisplaced pubic rami or sacral ala fracture, refer to endocrinology before assuming the problem is purely mechanical — more than 4 in 5 such patients will have an undiagnosed metabolic or endocrine disorder, most commonly vitamin D deficiency, that may be silently preventing healing.