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[Treatment of infected nonunion with large skeletal defects]
1Department of Orthopedics, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China. tianyazhichiz@sina.com
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).
Conclusion:
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.
