This retrospective series of 113 patients (one with bilateral non-unions, 114 cases total: 90 uninfected, 24 infected) treated at Berne between 1967 and 1976 examines rigid internal fixation with compression. It asks whether stability alone heals hypertrophic non-union and when bone grafting is actually needed. Femoral neck non-unions were excluded.
The mental model to carry from this paper: sort every non-union into hypertrophic versus atrophic before you plan the operation. A hypertrophic elephant-foot non-union is a stability problem. Give it rigid compression fixation and it will heal, no graft required unless you must correct a defect or shortening.
An atrophic non-union is a biology problem. Inert bone ends need decortication and cancellous grafting added to the fixation to restart osteogenesis. For the femur, remember the 21% first-operation failure rate tied to unaddressed medial cortical defects. Prefer a medullary nail, and if you plate, grasp that a medial gap must be grafted and compressed.
In infection, stabilize with external fixation, secure union first, then eliminate the infection. This sequence is the durable board-tested principle from AO teaching.
This retrospective series of 113 patients (one with bilateral non-unions, 114 cases total: 90 uninfected, 24 infected) treated at Berne between 1967 and 1976 examines rigid internal fixation with compression. It asks whether stability alone heals hypertrophic non-union and when bone grafting is actually needed. Femoral neck non-unions were excluded.
The mental model to carry from this paper: sort every non-union into hypertrophic versus atrophic before you plan the operation. A hypertrophic elephant-foot non-union is a stability problem. Give it rigid compression fixation and it will heal, no graft required unless you must correct a defect or shortening.
An atrophic non-union is a biology problem. Inert bone ends need decortication and cancellous grafting added to the fixation to restart osteogenesis. For the femur, remember the 21% first-operation failure rate tied to unaddressed medial cortical defects. Prefer a medullary nail, and if you plate, grasp that a medial gap must be grafted and compressed.
In infection, stabilize with external fixation, secure union first, then eliminate the infection. This sequence is the durable board-tested principle from AO teaching.