Liu David S, Snyder Brian D, Mahan Susan T
Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
Department of Orthopaedics, Boston Children's Hospital, Boston, MA, USA.
J Pediatr Soc North Am. 2024 Apr 9;7:100058. doi: 10.1016/j.jposna.2024.100058. eCollection 2024 May.
Delayed union and nonunion of fractures exist in the pediatric population. Fracture healing requires the synergistic collaboration of mechanical support and robust biological processes to allow endochondral ossification, reestablishment of bone continuity, and subsequent remodeling to strong lamellar bone. Failure of either mechanical stability or biology may manifest as delayed fracture healing. While early recognition of potential metabolic and pharmacologic risk factors may be addressed by pre-emptive treatment using nutritional and vitamin D supplements, definitive treatment of established nonunion requires a comprehensive approach.
(1)Delayed unions and nonunions are more common in adult bone but can also occur in pediatric bone.(2)Fracture healing requires synergistic collaboration of mechanical support and robust biological processes; treatment of nonunions should address both the biological and mechanical factors.(3)Vitamin D is an integral component of calcium absorption and bone health.
小儿人群中存在骨折延迟愈合和骨不连的情况。骨折愈合需要机械支撑和强大生物学过程的协同合作，以实现软骨内成骨、重建骨连续性，并随后重塑为坚固的板层骨。机械稳定性或生物学方面的失败都可能表现为骨折延迟愈合。虽然通过使用营养和维生素D补充剂进行预防性治疗可以解决对潜在代谢和药理学风险因素的早期识别，但对于已确诊的骨不连的确定性治疗需要一种综合方法。
（1）延迟愈合和骨不连在成人骨骼中更常见，但也可能发生在小儿骨骼中。（2）骨折愈合需要机械支撑和强大生物学过程的协同合作；骨不连的治疗应兼顾生物学和机械因素。（3）维生素D是钙吸收和骨骼健康的重要组成部分。
