Occurrence and treatment of nonunion in long bone fractures in children.

Abstract

Because of favorable local biological factors, nonunion is rarely seen in long bone fractures in children, and there are few studies on pediatric nonunion in the literature. Twenty-six children under 15 years of age diagnosed with long bone nonunion were examined, and 19 received treatment. Patients with pseudarthrosis due to tumors or congenital causes were excluded from the study. The following factors were assessed for each patient: age and sex; cause, location, and type of fracture; form of initial treatment; incidence of infection and type of bacteria produced; time between fracture and diagnosis; and type of nonunion. Twenty-two of the patients had fractures in the lower extremities, and 4 in the upper extremities. The femur was the most commonly affected bone (12 patients), followed by the tibia (10 patients). The average age of the patients was 9.6 years (range 1-15 years). The frequency of occurrence increased after the age of 6, and all patients but two were above this cutoff age. In each case, there was at least one factor contributing to nonunion, such as open reduction and insufficient fixation, open fracture, and infection. Of the 19 patients treated, 3 required reoperation. In our opinion, claims that pediatric nonunion is an extremely rare condition are exaggerated, and we do not agree that it is always due to an error in treatment. Nonunion does occur in children despite appropriate treatment, especially after the age of 6, and it may be resistant to therapy.