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Defining the Mean Angle of Diaphyseal Long Bone Non-Unions - Does Shear Prevail?

OBJECTIVES: To define the mean angle of a series of diaphyseal non-unions based on radiographic analysis.

DESIGN: Retrospective cohort study.

SETTING: Two level-1 trauma centers.

PATIENTS: One hundred and twenty patients presenting with non-union.

INTERVENTION: A mean non-union angle was calculated from a series of AP and lateral X-rays using a standardised technique. The non-union angle was then estimated in a single plane by considering the greater of the two measured angles. Additional data collected included patient age, sex, non-union site, initial fracture angle and original fracture pattern.

MAIN OUTCOME MEASUREMENT: Single plane non-union angle.

RESULTS: The mean angles of all non-union in coronal plane was 42 degrees (SD 17 degrees) and 42 degrees in sagittal plane (SD 18 degrees) and 48 degrees (SD 15 degrees) in single plane. The single plane non-union angle in fractures which were originally multiplanar was steeper to those occurring in originally single plane fractures (p 0.002) although both were close to 45 degrees. There was no significant difference in the non-union angles on sub-group analysis of cohort location, sex or anatomic location.

CONCLUSIONS: This study demonstrates the mean angle of diaphyseal non-unions from long bones of the lower limb approaches 45 degrees. This is noted in all types of fractures and is irrespective of anatomic location or sex. This confirms the hypothesis that shear is likely to play a role in the development of a non-union. This study provides further evidence that non-unions occur primarily due mechanical instability.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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