Pathophysiology of fracture nonunion
Non-union is a common complication that may not always be successfully addressed by a simple reoperation. Therefore, numerous literature reports are trying to find a golden treatment standard that is simple and practical to promote fracture healing. The cause of nonunion arises from mechanical and biological deficiencies that impair fracture healing. The ‘diamond concept’ by Giannoudis et al, suggests the need for 4 elements for a good balance and appropriate fracture healing. These elements are: osteogenic cells, osteoconductive scaffold, growth factors (IGF-1 and PDGF) and a good environment for fracture union. However, in fact stability plays the most important part in facilitating bone union. Optimal tensile and compressive forces at the fracture site are the key of success.