Modified Nicoll-graft treatment of gap non-unions in the upper extremity

Sixteen gap non-unions (seven in the radius, eight in the ulna, and one in the humerus) in fifteen patients were treated with a full-thickness corticocancellous iliac-crest graft, 1.2 to 2.5 centimeters in length, to replace the bone loss, and with a compression plate to provide stability. Thirteen of the fifteen fractures with adequate follow-up united and the grafts were incorporated in an average of 13.5 weeks, an 87 per cent success rate. The stability achieved by the compression plate allowed early removal of the plaster cast and institution of active exercises. In the two failures, the graft was not resorbed, and it filled the gap in the bone but failed to unite at one end.