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Although open reduction and internal or external fixation can reduce complications of fractures, however, there are still 5%-10% nonunions occurred. The causes of nonunion are composed of systemic factor, local factor and medication factor, among them, the local factor is the main reason.


To investigate the local factors of nonunion of fractures after fixation using different fixators in limbs.


Eighty-seven cases of nonunion of fractures after fixation with different fixators in limbs between January 2005 and June 2011 were analyzed retrospectively. Analyzing and judging the specific local factor and calculating its proportion. The iatrogenic local factors included: invalid fixation, ignoring protecting the blood supply, ignoring bone graft, fracture reduction below the standard, postoperative infection and lacking proper rehabilitation guidance; patient-related factors included: severe injury, special location and early excessive activity.


The iatrogenic factors accounted for 73.0%, the patient-related factors accounted for 27.0%. In the iatrogenic factors from high to low were: ignoring bone graft 26.1%, lacking proper rehabilitation guidance 23.9%, invalid fixation 21.7%, fracture reduction below the standard 15.2%, ignoring protecting the blood supply 8.7%, postoperative infection 4.3%. In the patient-related factors from high to low were: early excessive activity 50.0%, severe injury 32.4%, special location 17.6%. Among the general factors, the objective factors accounted for 13.5% and the subjective factors accounted for 86.5%. Reducing the iatrogenic factors is an important part of reducing the nonunion of fractures after internal fixation treatment.

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