Current strategy for femoral/tibial non-unions is:
And despite all above those non-unions do not have any significant tendency to heal in a reasonable period of time. Why not? In my opinion the key is in neutralising the shear forces.
I am presenting a 2-year old femoral non-union which started as a complex femoral fractures - segmental (double segmental) and open.
Proximal fracture (neck of femur) and distal fracture (condyles) have healed nicely when shaft fracture didn't. The metalwork used did not fail, but the fracture did not unite. 2 years are probably long enough time to declare a non-union. In meantime also open tibia fracture which required soft tissue cover and bone transport healed. So there is a biological potential.
Initial fixation images are below.
Definitve fixation during the healing process.
But then a non-union ( 2 years after the injury).
Middle of November 2016
Decision was made to proceed with removing of the existing metalwork and neutralising the shear forces which I believe understand a bit more.
Definitive X-rays after the revision non-union surgery.
Is this to optimistic, or maybe it will heal anyway? Time will tell.
16 November 2016
All wounds healed. Still pain in the thigh and ankle as well. Overal patient is OK, optimistic. Pain in the thigh present before the surgery has changed.
X-rays below show good progress toward union.
17 March 2017
Pain has diminished significantly. Patient is walking unaided with still a bit of a limp. Constant improvement.
X-rays below are self-explanatory - non-union gone. Even faster then expected.