Only complete failure of union will be considered in this discussion and report. Delayed union is not included. I have not considered any true cases of nonunion until at least six months has elapsed. The principal causative factors in nonunion of the shaft of the humerus are, first, failure of reduction and maintenance of reduction and fixation for a sufficient length of time; second, failure of direct bony contact, prevented by interposition of soft tissue; third, early operative intervention with insertion of nonabsorbable material, and, fourth, constitutional or debilitating diseases and metabolic changes. I will not go into the details of the physiology and biology of wound healing, but it is necessary to understand certain fundamental laws regarding bone healing to consider nonunion effectively. The work of Leriche and Policard is a monumental treatise on this subject and explains in detail the pathologic physiology of ossification and healing of fractures.
OWEN WB. UNUNITED FRACTURES OF THE SHAFT OF THE HUMERUS: CHAIRMAN'S ADDRESS. JAMA. 1933;101(8):569–571. doi:10.1001/jama.1933.02740330001001
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