[Treatment of infected nonunion with large skeletal defects].
OBJECTIVE
To investigate the curative effect of managing infected nonunion with large skeletal defects utilizing debridement and granulated cancellous bone grafting.


METHODS
Nineteen patients (20 sites) of infected nonunion with large skeletal defects in tibiae (n = 18) or ulna/radii (n = 2), 18 males and 1 female aged 31.3 (8 - 51), were treated with debridement, external fixation, and granulated cancellous bone grafting, 14 patients (15 sites) by cancellous bone autografting and 5 patients (5 sites) by cancellous bone allografting. Follow-up was conducted for 32.7 (20 - 56) months.


RESULTS
Out of the 5 patients receiving allografting, 3 gained bone union with an external fixator index of (2.22 +/- 0.84) months/cm, 2 developed nonunion and subsequently gained union after receiving cancellous bone autografting, and no infection recurrence all of the 5 patients were found. Out of the 14 patients (15 sites) undergoing autografting, 2 patients (2 sites, 13.3%) developed nonunion due to recurrent infection resulting in absorption of autograft, subsequently received debridement and autografting once again, and gained bone union and infection eradication; 12 patients (13 sites, 86.7%) gained bone union with an external fixator index: of (1.96 +/- 0.74) months/cm. Re-fracture occurred in 3 patients (4 sites) and was cured by using cast immobilization (1 case), external fixator (1 case), or internal fixation (1 case).


CONCLUSIONS
Granulated cancellous bone autografting is a suitable method for managing infected nonunion with large skeletal defects. And cancellous bone allografting has a higher incidence of re-nonunion and longer time for using external fixator.
Lu
Wei-Ju
WJ
Department of Orthopedics, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China. tianyazhichiz@sina.com
Li
Bin
B
Liu
Gang
G
Zeng
Xiao-Feng
XF
Zhang
Xing-Quan
XQ
Zhang
Jun-Jie
JJ
Qian
Hong-Bo
HB
Chen
Yong
Y
Zhao
Jian-Ning
JN
D000293:Adolescent; D000328:Adult; D001850:Bone Diseases, Infectious / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D003646:Debridement; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult