Clinical management and innovation in fracture nonunion.

With the introduction and continuous improvement in operative fracture fixation, even the most severe bone fractures can be treated with a high rate of successful healing. However, healing complications can occur and when healing fails over prolonged time, the outcome is termed a fracture nonunion. Nonunion is generally believed to develop due to inadequate fixation, underlying host-related factors or infection. Despite the advancements in fracture fixation and infection management, there is still a clear need for earlier diagnosis, improved prediction of healing outcomes and innovation in the treatment of nonunion. This review provides a detailed description of nonunion from a clinical perspective including state of the art in diagnosis, treatment, and currently available biomaterials and orthobiologics.Subsequently, recent translational development from the biological, mechanical and infection research fields are presented including the latest in smart implants, osteoinductive materials and The first challenge for future innovations is to refine and to identify new clinical factors for the proper definition, diagnosis and treatment of nonunion. However, integration of in vitro, in vivo, and in silico research will enable a comprehensive understanding of nonunion causes and correlations, leading to the development of more effective treatments.