FRACTURE NON-UNION

Approximately 10% of fractured patients present consolidation delay or failure. This can be due to several factors, the most common being comminution, infection, inadequate fixation, tumors, lack of blood supply, metabolic alterations, and systemic diseases. Some drugs have been implicated in the pathogenesis. It is difficult to find uniform criteria of no consolidation, but if after 6-8 weeks of immobilization there is lack of radiological signs of good callus formation, some orthopedic surgeons diagnose consolidation delay, while others require longer intervals (up to 6 months) before making the diagnosis. This review considers the biological process of bone repair, the mechanisms implicated in consolidation delay in fractured elderly patients, and the medications used to treat the problem after diagnosis (vitamin D, calcitriol, microcrystalline hydroxyapatite, strontium ranelate, and parathyroid hormone). Finally, three cases with good response to medical management are shown.