ReviewInternational orthopaedics2018
Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations.
Review in International orthopaedics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 126 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
126 citing papers in PubMed, 2 syntheses or guidelines pooled it, 245 citations in OpenAlex.
- Efficacy and Safety Evaluation of Intramedullary Nail and Locking Compression Plate in the Treatment of Humeral Shaft Fractures: A Systematic Review and Meta-analysis.Computational and mathematical methods in medicine · 2022Pooled it
- Platelet-Rich Plasma Combined With Autologous Grafting in the Treatment of Long Bone Delayed Union or Non-union: A Meta-Analysis.Frontiers in surgery · 2021Pooled it
- Primary dynamization versus standard static interlocking nailing in treatment of tibial shaft fractures in adults: a randomized controlled trial.BMC musculoskeletal disorders · 2025Trial
- Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study.BMC musculoskeletal disorders · 2022Trial
- Percutaneous administration of allogeneic bone-forming cells for the treatment of delayed unions of fractures: a pilot study.Stem cell research & therapy · 2021Trial
- Do Systemic Factors Influence the Fate of Nonunions to Become Atrophic? A Retrospective Analysis of 162 Cases.BioMed research international · 2019Trial
- Timed Up-and-Go Test Using Instrumented Insoles to Monitor Tibial or Malleolar Fracture Healing in Patients With Healing Fractures or Nonunion: Longitudinal and Cross-Sectional Exploratory Study.JMIR mHealth and uHealth · 2026Article
- Same-day discharge does not increase complications or readmissions in carefully selected patients undergoing aseptic lower extremity nonunion surgery.OTA international : the open access journal of orthopaedic trauma · 2026Article
- Unidirectional porous beta-tricalcium phosphate supports three-dimensional osteogenic differentiation of human iPS cells without surface coating.Bone reports · 2026Article
- Postoperative Intravenous Ketorolac Does Not Affect Nonunion Risk in Surgically Treated Long Bone Shaft Fractures.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Augmentation Plating with Intramedullary Nailing for Aseptic Long Bone Non-union: A Prospective Observational Study of Clinical, Radiological, and Functional Outcomes.Journal of orthopaedic case reports · 2026Article
- Timing for Intravenous Injection of Mesenchymal Stem Cells to Enhance Fracture Healing.Journal of functional biomaterials · 2026Article
- Sustained Decrease in Oxygen Saturation in Human Fibular Fractures Monitored with Laser-Doppler and White-Light Spectroscopy: A Longitudinal Observational Pilot Study.Journal of functional biomaterials · 2026Article
- IL-1β/EPAS1-Associated Ferroptotic Stress Impairs Skeletal Stem/Progenitor Cell Function in Inflammation-Associated Fracture Nonunion.Current issues in molecular biology · 2026Article
- The course of treatment in nonunions of long bones: can we predict when exchange nailing may fail?European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Eccentric Hexapod external fixator assisted closed reduction and intramedullary nail fixation for the treatment of femoral shaft fractures.BMC musculoskeletal disorders · 2026Article
- Atrophic Long-Bone Non-Union: Current Insights into Pathogenesis and Management-A Narrative Review.Journal of clinical medicine · 2026Review
- Excellent clinical and radiological outcome of disabled upper extremity after humerus hypertrophic nonunion with implant failure in geriatric patient treated with compression plate: A case report.Trauma case reports · 2026Article
- Article
- Animal models for critical-sized long-bone defects and long-bone non-union: a scoping review.Journal of orthopaedic surgery and research · 2026Article
66 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The intention of the current article is to review the epidemiology with related socioeconomic costs, pathophysiology, and treatment options for diaphyseal long bone delayed unions and nonunions. Diaphyseal nonunions in the tibia and in the femur are estimated to occur 4.6-8% after modern intramedullary nailing of closed fractures with an even much higher risk in open fractures. There is a high socioeconomic burden for long bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration. The classic classification of Weber and Cech of the 1970s is based on the underlying biological aspect of the nonunion differentiating between "vital" (hypertrophic) and "avital" (hypo-/atrophic) nonunions, and can still be considered to represent the basis for basic evaluation of nonunions. The "diamond concept" units biomechanical and biological aspects and provides the pre-requisites for successful bone healing in nonunions. For humeral diaphyseal shaft nonunions, excellent results for augmentation plating were reported. In atrophic humeral shaft nonunions, compression plating with stimulation of bone healing by bone grafting or BMPs seem to be the best option. For femoral and tibial diaphyseal shaft fractures, dynamization of the nail is an atraumatic, effective, and cheap surgical possibility to achieve bony consolidation, particularly in delayed nonunions before 24 weeks after initial surgery. In established hypertrophic nonunions in the tibia and femur, biomechanical stability should be addressed by augmentation plating or exchange nailing. Hypotrophic or atrophic nonunions require additional biological stimulation of bone healing for augmentation plating.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.