This describes a fracture which is taking longer to unite than expected. It is often difficult to distinguish from the situation of non-union as in both, the fracture line remains visible. However, in delayed union, the fracture site is tender, the bone may appear to move in one piece, and x-ray does not show sclerosis of the fragment ends. Serial x-rays confirm slow but definite healing. However, the fracture is not united and may displace if stressed excessively.
Delayed union rarely requires operative intervention. More usually, it indicates a need to review current management - is the cast tight enough to stabilise the fracture, is traction excessive, should an alternative method of holding the fracture be considered - or more simply, to wait a bit longer. However, failure to unite after 6 months without evidence of callus formation, frequently necessitates operative intervention.
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