title: Judet osteoperiosteal decortication for treatment of non-union: the Cornwall experience.
abstract: BACKGROUND
  The treatment of non union can be challenging with a variety of surgical options available to achieve bone consolidation. Robert Judet first described a method of osteo-periosteal decortication in 1963. He stated that by elevating cortical chips that remain attached to the periosteum and overlying soft tissues surrounding the site of non-union, combined with mechanical support, the bone consolidated. Despite excellent results presented in 2008 of 99% union rates with a mean delay of 8 months, the technique has not yet become popularised. We aim to show that Judet's method of decortication can achieve good results in the management of failure of union in a hospital other than Judet's.
  
  
  METHODS
  Retrospective analysis was performed from December 2002 to December 2008 of 40 cases in 39 patients of osteoperiosteal decortication for fracture non-union. Concurrent stabilisation was with internal fixation only. All procedures were performed by one surgeon (MN) using the Judet technique after learning the technique in the originators hospital. A preoperative non union scoring system was also used to assess its use in predicting persistent non-union.
  
  
  RESULTS
  Union was successfully achieved in 36 of the 39 surviving cases (92.3%) after a median delay of 8 months (range 3-47, SD 9.2) Twenty-six patients (65%) achieved union following the decortication procedure without subsequent operations. Factors such as open fracture and smoking did not have a statistically significant effect on union. The mean number of procedures following decortication was 0.68 (range 0-4). Metalwork failure occurred in 11 cases (28%), the majority in femoral decortications (n=9, 82%). The femur was the site of all persistent non unions in the series. Three patients had superficial infections and two had deep infections. The pre-operative non union scoring system (0-100) means were noticeably worse for the persistent non union group 42.0 (20-46) compared with the union group 31.0 (range 4-52).
  
  
  CONCLUSIONS
  Osteoperiosteal decortication remains a highly effective surgical technique in the management of failed fracture union. The non union scoring system is a reliable predictor of persistent non union after this type of surgery.
  
  
  CONCLUSIONS
  Relevant to general trauma orthopaedic surgeon and specialist orthopaedic surgeons with an interest in fracture non-union.
authors.affiliation: Royal Devon & Exeter Hospital, Barrack Rd, Exeter, EX2 5DW, United Kingdom. paul_guyver@hotmail.com
authors.forename: Paul
authors.initials: P
authors.lastname: Guyver
authors.forename: Christopher
authors.initials: C
authors.lastname: Wakeling
authors.forename: Kumar
authors.initials: K
authors.lastname: Naik
authors.forename: Mark
authors.initials: M
authors.lastname: Norton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome