Nonunion of fractures in pediatric patients: 15-Year experience at a level I trauma center

There is little data evaluating the risk factors, demographics, and prognoses for nonunions in children. Previous literature has reviewed time periods when contemporary techniques of internal fixation and management of open injuries had not been available. The purpose of this retrospective study was to evaluate a large consecutive series of pediatric nonunions treated at a level I trauma center. Between 1985 and 2000, 43 nonunions in 42 pediatric patients with a mean age of 9 years and 9 months (range, 3-14 years) were identified at our level I trauma center. Eleven of the original 43 fractures were open and 5 presented with active infection. Patients were observed until union or a minimum of 1 year with a mean follow-up of 50 months. Twenty of 43 nonunions (47%) were located around the elbow. Seventeen of 43 nonunions (39%) were diaphyseal. The operative fractures required a mean of 3.6 surgeries (range, 1-19 surgeries) to achieve bony union. All secondary attempts to achieve union were successful at last follow-up. Although nonunions in the pediatric population are rare, these data underscore the importance of careful evaluation and treatment of these fractures at risk for nonunion.