Complications of foot surgery. Nonunions and related disorders

Management of malunions, delayed unions, and nonunions is a complex task that initially requires appropriate diagnosis and classification. Diagnostic modalities currently used include radiography, fluoroscopy, tomography, computed tomography, and radionucleotide evaluations. Based on these evaluations, nonunions may be classified as hypervascular or avascular in nature. Determining the presence of a synovial pseudoarthrosis or infection is also vital to nonunion management. Current treatment regimens available include combinations of cast immobilization, electrical stimulation, and surgical repair with and without bone graft. Internal and external fixation also provide rigid stability to promote healing of nonunion sites. Infected nonunions should be managed with appropriate surgical debridement and antibiotics. Internal fixation in the presence of infection may not necessarily need to be removed. There is no single best method for treatment of nonunions. Therapy must be tailored to each individual to provide a cure.