Management of Fracture Non-union in Children: A Literature Review With Two Case Studies

Paediatric non-union has significant implications for patients, their families, and the wider healthcare system. These implications can be clinical, such as delayed development and poor functionality, as well as psychological with respect to their overall well-being. As such, this necessitates a greater understanding and implementation of evidence-based treatment strategies to manage and prevent paediatric non-union. This study investigates the efficacy of different treatment strategies for paediatric non-union, in the form of a literature review supplemented by an analysis of two cases which presented to our local unit(s): case 1 being a four-year-old girl with a non-union of a Milch type 2 left lateral condyle fracture and case 2 being a seven-year-old boy with a non-union of a left clavicle fracture. A comprehensive literature search, on the basis of predetermined inclusion and exclusion criteria, was initially performed capturing data from 2013 to 2023 and later refreshed to the year 2025. Articles were identified using the databases PubMed, PubMed Central, Google Scholar, ResearchGate, and ScienceDirect, with an emphasis on investigating treatment efficacy for paediatric non-union. Multiple treatment options exist for effectively addressing non-union in paediatric patients, including bone grafting, ring fixation, valgus osteotomy, and the use of bone morphogenetic proteins (BMPs). Bone grafting has been the most efficacious treatment method so far, with limited complications. Of note, injury location and characteristic morphology of the non-union are the most important in determining treatment for the said non-union. Autologous bone grafting has demonstrated the best efficacy, exhibiting up to a 100% success rate in managing complex non-unions in children with few complications.