Treatment of non-unions with bone defects: which option and why?

Bone defects associated with non-unions occur as a result of the initial insult or as a consequence of bone excision following non-union development. Historically management of this clinical scenario consisted mainly of amputation, which provided a short recovery period but a significant loss of limb function. Today treatment has evolved and multiple options are available for reconstruction of the bone defect. Broadly these are: bone shortening with lengthening later or bone transport and 'docking' (distraction osteogenesis based techniques); the use of vascularised and non-vascularised bone grafts; bone substitutes; stem cells; growth factors; scaffolds and gene therapy.