Treatment of nonunion has radically changed in recent years. We define nonunion as a fracture of bone induced either by trauma or surgery which does not show clinical or radiographic signs of progression to healing within a reasonable time span. The reparative processes are present but inadequate. Fracture healing may be considered to be a balance between repair and breakdown processes at the fracture site. When breakdown exceeds repair, nonunion is the result. Altering the conditions at the fracture site even marginally in favour of repair will eventually lead to bony continuity being restored. Nonunion treatment should follow three principles: a) realignment; b) stabilization; and c) stimulation. Any surgical proce dure should address one or all of these areas. In this article the principles of nonunion management are explained, together with different bone healing stimulation techniques and our clinical results.
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