Endoscopic treatment of delayed unions and nonunions with calcium phosphate paste

We describe a new therapeutic procedure using a bone filler in a calcium phosphate paste (bone paste) for endoscopic surgery for delayed unions and nonunions. Guided by radiography, the site of nonunion was confirmed. Two portals were created toward the nonunion site and, through each portal, the tissue around the nonunion site was released. While confirming the site of nonunion under endoscopy, scar tissue at the nonunion was excised to expose the bone. Next, the bone paste was injected into the space between bone fragments. This therapeutic modality is indicated most favorably in cases of open fractures, in cases after replantation in which soft tissue is severely damaged but one wants to preserve as much soft tissue as possible, and in cases of nonunion with satisfactory fixation but insufficient callus formation.