Bone grafting techniques in treating fracture nonunion.

A fracture nonunion is not uncommon and the principle of treatment has been well established. Traditionally, for the efficacy of treatment, a nonunion is classified as a hypervascular (hypertrophic) or an avascular (atrophic) type. Methods for treating nonunion are multiple and bone grafting techniques have been the most convincing and widely used. Bone grafts can be divided into allografts and autografts and cortical or cancellous bone grafts; each has its individual function. However, both types of a nonunion need to be supplemented with cancellous bone graft to increase the rate of success. Basically, effective treatment should include making fracture gaps vanish, providing sufficient stability, and initiating osteogenic power. Clinically, use of the closed bone grafting technique is preferable when possible. However, the critical size for using the closed technique to treat segmental bony defects has yet to be defined, and the open technique should be utilized whenever the effectiveness of the closed technique is in doubt. To simplify the surgical procedure and to reduce morbidity at the donor site, bone graft substitutes should be continuously investigated.