Fracture nonunion: classification, evaluation and management strategies-a structured approach for higher orthopaedic examinations.

PURPOSE: Fracture nonunion is a clinical challenge that can lead to prolonged disability and significantly impaired quality of life. This review summarises current evidence on its evaluation and management, emphasising the principles relevant to higher orthopaedic examinations. METHODS: A structured narrative review of relevant literature, focusing on classification, risk factor assessment, diagnosis and surgical management of fracture nonunion, is presented. Systematic reviews, established guidelines and clinically relevant studies are considered, allowing for a practical, principle-based approach to be described. RESULTS: Fracture nonunion is a multifactorial condition that requires comprehensive assessment, including patient- and injury-related risk factors, adequate imaging and laboratory testing. Nonunion management strategies are based on the optimisation of the biological and mechanical environment. CONCLUSION: Fracture nonunion represents a complex condition that requires multidisciplinary management within specialist centres. Selection of the optimal strategy should be based on an assessment of both biological and mechanical factors contributing to impaired fracture healing. Fracture-related infection should be considered in all cases of nonunion, and appropriate evaluation should be undertaken.