CT scans can confirm or exclude bridging callus where their is doubt on bony union
Delayed union
Different fractures heal at different rates, and healing is dependent on the energy of the injurty as well as the age and overall health of the patient
The tibia is one of the slowest healing bones - fractures typically take around 16 weeks to heal and can take over a year to unit
Femoral shaft also typically take 3-4 months to heal
Metaphyseal fractures tend to heal more quickly than cortical fractures
A delayed union is a fracture that is not healed within the expected time
Infection can result in a delayed union
If infection is diagnosed, healing can occur if the infection is suppressed with antibiotics however the fracture may go on to an infected non-union
Non-union
Hypertrophic non-union can occur due to instabiity and excessive motion at the fracture site
Atrophic non-union can occur due to rigid fixation with a fracture gap, lack of blood supply to the fracture site, chronic disease or soft tissue interposition
Infection can also lead to atrophic or hypertrophic non-union
Some fractures are particularly prone to problems with healing due to poor blood supply:
Scaphoid waist fractures
Fractures of the distal clavicle
Subtrochanteric fractures of the femur
Jone's fracture of the fifth metatarsal
Some intra-articular fractures may not unite due to synovial fluid inhibiting healing if a fracture gap exists (intracapsular hip fracture, scaphoid fracture)
Malunion
Fracture has healed in a non-anatomic position sufficient to cause pain, stiffness, loss of function and deformity
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