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Hypertrophic Non Union

- Discussion:
    - finding include hypertrophy of bone ends & sclerosis at 6 months post injury;
    - these non unions theoretically have sufficient vascularity to heal but stability is lacking or normal axial alignment has not been restored;
    - it is important to point out, however, that even with the radiographic appearance of a "classic" hypertrophic nonunion, vascularity may be impaired;
    - non union results from mechanical problem of poor fixation or reduction as well as possible diminished vascularity;
    - compared to atrophic nonunion, the hypertrophic nonunion has better biologic propensity to heal;
    - when stability & good axial alignment are established, hypertrophic non unions will usually heal in a relatively short period of time;

- Radiographs:    

- Treatment:
    - hypertrophic nonunions of tibia w/ intact fibula may be treated w/ partial fibulectomy (1-2 cm)
          and full weightbearing in plaster cast;
          - if fracture vascularity is not comprimised and bony sclerosis is not excessive, then expect success rate of > 75;
          - disadvantages:
                  - may increase tibial fracture instability, and may be contra- indicated w/ fracture angulation;
                  - may interfere w/ future posterolateral bone grafting;
    - application of bone graft is not necessary for these fractures to heal;
          - in contrast, hypotrophic nonunions require bone grafting along w/ stabilization inorder to heal;
    - alternatively hypertrophic nonunions will go on to heal w/ application of rigid fixation (plate, an intramedullary nail, or an external fixator);
          - if fractured fragments are adequately aligned, debridement of the non-union, is not required

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