Abstract:  Objective To analyze the causes of postoperative healing of limb long bone fractures, and to provide references or ideas for the identification of medical injuries related to nonunion of limb long bone fractures. Methods 175 cases of nonunion of limb long bone fracture after operation which were handled by our center from 2011 to 2018 and published by China Judicial Documents Network in 2017-2018 were analyzed and summarized. Results There were many factors affecting the healing of limb long bone fracture, mainly related to internal fixation of fracture, and the degree of medical fault participation was relatively concentrated （about 40%）. Conclusion The identification of medical damage caused by postoperative nonunion of limb long bone fracture should focus on the relevant factors of operation, and pay attention to the postoperative treatment measures. Combined with the patient's trauma and their own health factors, comprehensive analysis should be made to objectively evaluate the fault participation.

Key words: medical damage, limb long bone, fracture nonunion, forensic medicine

摘要： 目的 对影响四肢长骨骨折术后愈合的原因进行分析，为四肢长骨骨折不愈合相关医疗损害鉴定提供借鉴或思路。方法 选取本中心2011—2018年间办理的及“中国裁判文书网”2017—2018年度公布的175例四肢长骨骨折术后不愈合医疗损害责任纠纷案例进行分析总结。结果 影响四肢长骨骨折愈合的原因较多，以骨折内固定相关因素为主，该类医疗损害鉴定意见认定的医疗过错参与度相对较为集中（多在40 %左右）。结论 四肢长骨骨折术后不愈合医疗损害的鉴定需重点关注手术相关因素，同时还需注意术后处理措施，结合患者外伤及其自身健康因素，综合分析，对过错参与度作出客观评价。

关键词: 医疗损害, 长骨, 骨折不愈合, 法医学