OR2.14 | Fracture Complication Investigation — Summary & Reflection

KEY TAKEAWAYS

This module covered three major complications of fracture healing that require systematic investigation before management can be planned. Malunion (fracture healed in unacceptable position) is investigated with long-leg standing radiographs and CT scanogram to quantify angulation, rotation, and shortening; management is corrective osteotomy. Non-union (failure to heal beyond the expected timeframe) is classified by the Weber–Cech system into hypertrophic (abundant callus, mechanical problem — fix with rigid stabilisation alone) and atrophic (absent callus, biological problem — requires bone graft plus stabilisation). Radiological investigation includes plain films, CT for cortical bridging assessment, and MRI when infection is suspected. Biochemical screening (ESR, CRP, WBC) and intraoperative deep tissue biopsy (minimum 5 specimens) are mandatory when infected non-union is possible. Infected non-union combines the features of atrophic non-union and chronic osteomyelitis — the treatment pathway is strictly staged: surgical debridement → temporary external fixation → culture-directed antibiotics → delayed reconstruction with Masquelet/bone transport/free flap as appropriate. Superficial sinus-tract swabs are unreliable for organism identification and must not guide antibiotic choice.

REFLECT

Consider a patient in your clinic with an 8-month-old tibial fracture, a draining sinus, and normal WBC but elevated CRP. His previous surgeon planned bone-grafting surgery for next week. What investigations would you perform before that surgery, and what would you tell the patient and surgeon if the investigations pointed toward infected non-union? How does the staged management pathway for infected non-union challenge both patient expectations and surgical scheduling in a busy district hospital?