• Christian von Rüden, Sven-Oliver Dietz, Peter Schmittenbecher, Francisco F Fernandez, Justus Lieber, Björn Wilkens, Matthias Rüger, and Dorien Schneidmueller.
• Department of Trauma Surgery, BG Unfallklinik Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany. christian.vonrueden@bgu-murnau.de.
• Eur J Trauma Emerg Surg. 2021 Apr 1; 47 (2): 303-311.

PurposeLower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion.MethodsThirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated.ResultsThe mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well.ConclusionIf treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient's age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment.

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