[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 50.16.52.237. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Article
April 18, 1990

Orthopedic Surgery Turns Attention to Relatively Few Fractures That Fail to Heal Over Time

JAMA. 1990;263(15):2027-2028. doi:10.1001/jama.1990.03440150017005

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.

Abstract

FEWER than 5% of bone fractures fail to heal. But, that amounts to more than 100 000 clinically symptomatic nonunions each year in the United States at a total estimated treatment cost of $2 billion.

James D. Heckman, MD, bases those numbers on his definition of ununited fractures. He told a symposium at the American Academy of Orthopaedic Surgeons meeting in New Orleans, La, that a diagnosis should only be made 6 months after the initial injury and when no progress has been seen clinically or radiographically for at least 3 months.

Heckman, professor and chair of orthopedic surgery at the University of Texas Health Science Center in San Antonio, distinguishes "delayed" unions as those that "show progress—as long as the patient is showing clinical or radiographic progress, it [the fracture] must be defined as a delayed and not a nonunion."

But in some circumstances—tibial shaft fractures, for instance—they can

×