What is the recommended weightbearing approach in the nonunion setting to promote healing?

• A. Avoid early weightbearing
• B. Early weightbearing
• C. Bone graft only
• D. Observation

Answer: (A)

In a nonunion, the aim is to create a stable, low-strain environment at the fracture site so healing can bridge the gap. Loading the area too early—pushing weight on it before the fracture and fixation can tolerate it—increases micromotion and mechanical disruption of early healing processes. This excessive motion can prevent callus formation and promote ongoing nonunion, so protecting the limb with nonweightbearing or only toe-touch weightbearing is recommended until imaging shows that healing is progressing and the fixation is ready for increased loads. While other strategies (like bone grafting or revision fixation) may be needed to address biology or stability, the weightbearing approach itself should be conservative early on to promote eventual healing.