Treatment of infected pseudoarthrosis of limbs

It was not difficult to treat an infected pseudoarthrosis without loss of bone substance by "excision-decortication-drainage" in one stage. Union was obtained in 90% of the cases. The rest required additional bone grafts. In only one case out of 41 was there persistent infection. The problem of infected pseudoarthrosis with loss of bone substance and a sizeable defect was more difficult to solve. None of the several methods of treatment employed were without complications. When the overlying skin defect was large and impossible to close in the presence of persistent sepsis at the pseudoarthrosis defect, Papineau's two stage technique of wide excision first followed by insertion of spongious autologous grafts through the granulating defect, appeared secure with minimal risk of residual osteitis in nearly 90% of the cases. 15% of the cases had poor skin healing, requiring further treatment and 20% (nearly one in five) had a stress fracture through the grafted area. One out of 35 cases had persistent pseudoarthrosis and two had persistent infection. In ten selected cases of infected pseudoarthrosis of the tibia with large skin and bone defect, a one stage method of excision, bone grafting and primary skin cover with a local gastrocnemius flap was attempted. In seven cases, primary skin healing and bone union was achieved, one patient required further bone grafting and two had recurrence of sepsis. If properly planned, this one stage method may be indicated in selected cases of infected pseudoarthrosis of the tibia.