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Published on: December 9, 2022
Single-Stage Treatment Protocol for Presumed Aseptic Diaphyseal Nonunion
Louis F Amorosa1, Leon D Buirs2, Rens Bexkens2
1Department of Orthopaedic Surgery, New York Medical College and Westchester Medical Center, Macy Pavilion Room 008, Valhalla, NY 10595.
Introduction:
This article describes the general surgical technique for treating presumed diaphyseal nonunion with a one-stage procedure involving intraoperative removal of specimens for culture, revision open reduction and internal fixation (ORIF) with a plate or nail, and bone-grafting.
Step 1 Preoperative Evaluation:
Take a careful history, evaluate the extremity and wound, and note comorbidities and medications.
Step 2 Preoperative Planning:
Preoperative planning is essential before revision nonunion surgery.
Step 3 Debridement Implant Removal And Cultures:
Debride the nonunion site, remove all failed and loose implants, and take specimens for culture; withhold antibiotics until all culture specimens have been obtained.
Step 4 Open Reduction And Internal Fixation:
Reduce the fracture and use interfragmentary fixation and/or compression, or a bridging plate.
Step 5 Postoperative Care:
If any of the five cultures are positive, consult an infectious disease specialist with experience in treating musculoskeletal infections.
Results:
We have used this protocol at our institution for patients with prior fracture surgery who subsequently developed a nonunion, with or without implant failure, that had no obvious infectious etiology.IndicationsContraindicationsPitfalls & Challenges.
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