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Chapter-05 Infected Nonunions of Long Bones

BOOK TITLE: Neglected Musculoskeletal Injuries

Author
1. Jain Anil K
2. Maheshwari Aditya V
ISBN
9788184488890
DOI
10.5005/jp/books/11171_5
Edition
1/e
Publishing Year
2011
Pages
15
Author Affiliations
1. University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India, University College of Medical Sciences and GTB Hospital Delhi, India; Indian Journal of Orthopaedics, University College of Medical Sciences and GTB Hospital Delhi, India Editor, Indian Journal of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
2. Washington Hospital Center, Irving St NW, Washington DC 20010, USA
Chapter keywords

Abstract

Infected nonunions (INU) are one of the most perplexing dilemmas in orthopaedic surgery. It can develop after an open fracture, after a previous surgical intervention or as sequelae to chronic hematogenous osteomyelitis. It can be classified on the basis of bone gap and activity of infection into 2 types. Type (A): INU of long bone with non draining infection. Type (B): INU of long bone with draining infection. Each type can be subcategorized into two. (a) Bone gap £ 4 cm. (b) Bone gap > 4 cm. The goal in the reconstruction in INU involves control of infection and creation of healed and drainage free limb. The various steps are debridement of nonunion site, culture directed antibiotic, repeated debrima, skeletal stabilization, soft tissue and bony reconstruction. The choice for bony reconstruction include cancellous bone grafting, anterior bone graft beneath a flap, posterolateral bone grafting and tibiofibular synostosis, nonvascular cortical bone grafting and vascularised cortical bone grafting, allografting. The distraction histogenesis can achieve all in certain specific indications. The fracture stabilization by intramedullary nail or external fixator and single stage corticocancellous bone grafting is preferred for type A1. For type A2 autogenous fibular graft or distraction histogenesis is preferred method. For type B1, INU debridement and stabilization at first stage followed by open cancellous bone grafting and distraction histogenesis for type B2 INU is a preferred option.

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