title: Management of infected nonunion of the long bones by a multidisciplinary team.
abstract: Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope. We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture. At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union). The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.
authors.affiliation: Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bose
authors.affiliation: Gloucester Royal Infirmary, 8 Meadow Close, Sutton Coldfield B76 2QQ, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kugan
authors.affiliation: Oxford University Hospitals NHS Trust, Windmill Road, Oxford OX3 7HE, UK.
authors.forename: D
authors.initials: D
authors.lastname: Stubbs
authors.affiliation: Oxford University Hospitals NHS Trust, Windmill Road, Oxford OX3 7HE, UK.
authors.forename: M
authors.initials: M
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D055815:Young Adult
keywords: infection; nonunion; osteomyelitis