The open bone graft for septic nonunion

Abstract

Fifteen patients with actively draining septic nonunions were treated by a two-stage protocol consisting of (1) thorough and, if necessary, repeated debridement of nonviable bone, necrotic soft tissue, and dense scar tissue followed by stabilization with an external skeletal fixator; and (2) transplantation of cancellous bone into the exposed bone after it had become lined with granulation tissue. The graft, consisting only of fresh autogenous cancellous bone, is kept moist with physiologic irrigating solution throughout the granulation tissue stages of healing. The fractures were immobilized in fixators for an average of 7.5 months, until early maturation of the graft was complete. Some important technical considerations include: (1) waiting until all exposed bone is covered with granulation tissue; (2) applying biplanar external fixation; and (3) inserting a bone graft tissue mass larger in diameter than the bone being replaced. Thirteen fractures were healed and free of infection at follow-up evaluation, while two patients underwent amputation.