Orthopedic Surgery Turns Attention to Relatively Few Fractures That Fail to Heal Over Time

Paul Cotton
JAMA. 1990;263(15):2027-2028. doi:10.1001/jama.1990.03440150017005.
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FEWER than 5% of bone fractures fail to heal. But, that amounts to more than 100 000 clinically symptomatic nonunions each year in the United States at a total estimated treatment cost of $2 billion.

James D. Heckman, MD, bases those numbers on his definition of ununited fractures. He told a symposium at the American Academy of Orthopaedic Surgeons meeting in New Orleans, La, that a diagnosis should only be made 6 months after the initial injury and when no progress has been seen clinically or radiographically for at least 3 months.

Heckman, professor and chair of orthopedic surgery at the University of Texas Health Science Center in San Antonio, distinguishes "delayed" unions as those that "show progress—as long as the patient is showing clinical or radiographic progress, it [the fracture] must be defined as a delayed and not a nonunion."

But in some circumstances—tibial shaft fractures, for instance—they can


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