Nonunion of long bone fractures in children: a review of 30 cases.

Nonunions after diaphyseal fractures of long bones in children are rare. Thirty diaphyseal nonunions in 30 children are reported. The sites of nonunion were tibia (15), femur (5), ulna (4), humerus (3), radius (2), and fibula (1). Nonunions in children tend to occur after high-energy trauma, particularly when the fracture is compound, there is soft tissue loss, and infection develops. Open reduction and internal fixation may contribute to nonunion, particularly when the fixation is inadequate or holds the fracture apart. Repeated manipulation of the fracture after open reduction may also contribute to nonunion. Treatment of the nonunion must be individualized, but usually requires excision of the nonunion fibrous tissue, bone grafting, and internal fixation. Electrical stimulation was not used. The average time from fracture to union was 14.7 months, and multiple surgical procedures were required.