Failure of initial union, as when bone fragments are separated by soft tissue, may also lead to an atrophic non-union. Atrophic non-unions can be treated by stimulating blood flow and encouraging healing. This is often done surgically by removing the end layer of bone to provide raw ends for healing and the use of bone grafts. Oligotrophic nonunion
As the name implies, an oligotrophic nonunion demonstrates some attempt by the body to heal the fracture. These are thought to arise from adequate biology but displacement at the fracture site. Diagnosis
A diagnosis of nonunion is made when the clinician feels there will be no further bone healing without intervention. The FDA defines it as a fracture at least 9 months old that has not shown any signs of radiographic healing within the last 3 months. CT scans offer a closer look at the fracture and may also be used to evaluate how much of the fracture has healed. Blood tests can evaluate if the patient has adequate levels of nutrients such as calcium and vitamin D.  Blood tests can also look for markers of infection such as ESR and CRP. Treatment
Surgery
Currently, there are different strategies to augment the bone-regeneration process, however, there is no standardised clinical treatment guideline yet. Surgical treatment options include:
Debridement: radical surgical removal of necrotic or infected soft tissue and bone tissue is deemed essential for the healing process. Immobilization of the fracture with internal or external fixation.
Megaureter is a medical anomaly whereby the ureter is abnormally dilated. Congenital megaureter is an uncommon condition which is more common in males, may be bilateral, and is often associated with other congenital anomalies. The cause is thought to be aperistalsis of the distal ureter, leading to dilatation.The cutoff value for megaureter is when it is wider than 6 or 7 mm.A functional obstruction at the lower end of the ureter leads to progressive dilatation and a tendency to infection. The ureteric orifice appears normal and a ureteric catheter passes easily.Definitive surgical treatment involves refashioning the lower end of the affected ureter so that a tunnelled reimplantation into the bladder can be done to prevent reflux. References

Bailey and Loves Short Practice of Surgery


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