(ii) An update on fracture healing and non-union

The basic science underlying the process of bone healing has been a topic of intense research activity over the past 50 years. Increasing understanding of events on a molecular level has allowed a greater understanding of factors that might contribute to failure of these mechanisms. From this, it has been possible to introduce new treatment methods as adjuncts to traditional treatments, both for fresh fractures and established non-unions. Knowledge of these topics is essential to the day to day practice of the majority of orthopaedic consultants and as such is a favourite topic of examiners in both basic surgical and specialist orthopaedic examinations. This first half of this article strives to summarize current understanding of the biology of bone healing, highlighting recent advances. The second part is an overview of the aetiology and management of non-union and is illustrated with case studies.