Delayed Fracture Healing - Non-Union - Malunion - Differential Diagnosis Algorithm



Inflammation (Hours-Days) -> Soft Callus (Days-Weeks) -> Hard Callus (Weeks-Months) -> Remodeling (Years)



Delayed Union (3 - 6 months)

 • Tobacco / nicotine

 • NSAIDS

 • Ca2 / Vitamin D deficiency

Hypertrophic Non-Union (adequate blood flow)

 • Mechanical failure)

 • Excessive motion

 • Excessive bone gap

Atrophic Non-Union (inadequate blood flow)

 • Tobacco / nicotine

 • NSAIDS

 • Medications

 • Allergies

 • Biologic Failure

Functional Malunion

 • Small deviations from normal axis

Non Functional Malunion

 • Inadequate immobilization / reduction

 • Misalignment before casting

 • Premature cast removal



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