Deep decortication in nonunion of shaft fractures

For many years we have used the "petal" technique of Jarry and Uhthoff in all cases of delayed union or nonunion of long bones. With a chisel or a gouge, cuts are made in the cortical surface of the bone on both sides of the fracture line, and numerous scales are lifted but remain attached at the base, like the petals of a flower. Depending on the cortical thickness, the petals are 2 to 4 mm thick. The surface area of the bone is increased and the haversian canals under the cortical surface (and the blood vessels) are cut open, exposing numerous areas of well-vascularized and highly osteogenetic tissue on all of the exposed surface of the bone. We were able to retrace 26 cases treated in this way between 1968 and 1988. Different types of fixation were used, depending on type and location of the fracture, but sometimes also because we preferred not to change the fixation that had been applied before the patient was referred to us. All fractures united after one operation, in 3 to 18 months. In one case of nonunion of the ulna, with bone loss by gunshot wound, the fracture united, but a stress fracture through a screw hole occurred distally to the fracture site. It did not unite and reoperation was refused. In most cases we have added autogenous spongiosa only grafts, but we think now that their use is questionable in many instances. This technique is quite similar to the subperiosteal decortication of Judet or the shingling technique as described by Forbes.(ABSTRACT TRUNCATED AT 250 WORDS)