Cutting Edge Orthopedics - Issue 3

4 • CUTTING EDGE - ORTHOPEDICS period of months. Failed soft tissue coverage, failure to eradicate the infection, or failure to obtain boney union may lead to eventual amputation. Weber and Čech [10] classified nonunions radiographically based on their biological poten- tial. Hypertrophic nonunions are characterized by abundant bone formation and are often referred to as having the appearance of an elephant foot. In general, they are stiff and relatively stable. Patients are often able to weight bear with pain on a hypertrophic nonunion. They have excellent blood supply and biological potential, and often require only the addition of stability for the fracture to unite (Fig. 1). Atrophic nonunions, on the other hand, have little biological poten- tial. Atrophic nonunions are often the result of open fractures or previous surgical procedures Fig. 1: A 13-year-old girl hit by a light pole while waiting for the school bus. ( a, b ) Anteroposterior (AP) and lateral of the hypertrophic nonunion with deformity. ( c ) Application of a multiplanar external fixator to add stability, no fracture exposure, deformity correction. ( d, e ) AP and lateral of fracture union after frame removal.