101 Fracture Nonunion

Fracture Nonunion

Hema N.Choudur, Anthony G. Ryan, and Peter L. Munk

Clinical Presentation

A young man had had a motor vehicle accident several months prior to presenting. He had had a fracture of the right tibia, which had been casted; however, follow-up radiographs did not show any healing. Because there was severe pain at that site, an MRI was recommended to visualize any bony union and to exclude infection.

Figure 101A

Figure 101B

Figure 101C

Radiologic Findings

The MRI (Fig. 101A, sagittal MPGR; Fig. 101B, coronal FSTIR; and Fig. 101C, axial T1-weighted fatsaturated postgadolinium) reveals no osseous union between the fractured fragments. Although edema is evident in the adjacent marrow, there is no abnormal enhancement postgadolinium to suggest infection.

Diagnosis

Nonunion.

Differential Diagnosis

Delayed union

Malunion (Figs. 101D to 101G)
Infection

Figures 101D–101G AP (101D) and lateral (101E) views of the tibial fibula show marked angular deformity at the site of an old, healed fracture consistent with malunion. An osteotomy and plate fixation were required for correction as seen on the AP (101F) and lateral (101G) postoperative radiographs.

Discussion

The repair of a fracture is a continuous process, with the fracture tender and slightly mobile in the early stages becoming immobile and nontender in the later stages, noticeably seen on plain radiographs as bony fusion as against callus formation in the early stages.

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