Non-Union in Upper Limb Fractures - Clinical Evaluation and Treatment Options

Area of Science:

• Orthopedic Surgery
• Traumatology
• Bone Healing Research

Background:

• Upper limb non-unions, though rare, present significant challenges with high failure rates for current treatments.
• Risk factors include fracture gap size, bone loss, and internal/external factors, with up to 30% non-union rates after surgery for long bone fractures.
• Non-unions severely limit range of motion, impacting adjacent joints (shoulder, elbow, wrist) and overall patient activity.

Purpose of the Study:

• To provide a comprehensive overview of upper limb non-unions, including their causes, clinical evaluation, and treatment options.
• To discuss recommendations for managing these challenging fractures based on current literature and clinical experience.
• To highlight the incidence and common types of non-unions in the upper limb.

Main Methods:

• Review of current literature on upper limb non-unions, focusing on risk factors, clinical presentation, and treatment outcomes.
• Analysis of clinical experience regarding the incidence and management of upper limb fractures.
• Identification of common non-union types and their frequency.

Main Results:

• Upper limb non-unions account for only 1.7% of surgically managed upper limb fractures in the authors' experience.
• Clavicle and humeral fractures are the most frequent sites for upper limb non-unions.
• Atrophic non-union is the predominant type (57%), with osseous healing achieved in a mean of 6.45 months after revision surgery.

Conclusions:

• Successful management of upper limb non-unions requires thorough investigation of causes and a tailored treatment plan.
• While non-operative treatment is possible in select cases, revision surgery is frequently necessary for osseous healing.
• Effective treatment strategies, including osteosynthesis and bone grafting, are crucial for restoring function and improving patient outcomes.