Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2007 Apr;20(2):206-214. Korean.
    Published online Jun 14, 2016.
    https://doi.org/10.12671/jkfs.2007.20.2.206
    Copyright © The Korean Fracture Society. All rights reserved
    Review

    Treatment of Infected Nonunion

    Sang-Ho Ha, M.D.
      • Department of Orthopedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea.
    • Address reprint requests to: Sang-Ho Ha, M.D. Department of Orthopedic Surgery, Chosun University Hospital, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. Tel:82-62-220-3147, Fax: 82-62-226-3379, Email: shha@chosun.ac.kr

    Figures

    Fig. 1
    (A) The radiograph shows tibia proximal shaft fracture with LCP applied. The patient showed pus discharge from the fracture site and loosening of the implants.
    (B) Implant removal and debridement of the infected nonunion site was done with stabilization using external fixator.

    (C) Last follow up radiograph shows complete bone union with good alignment.

    Fig. 2
    (A) Debridement and antibiotic mixed cement bead insertion was done but infection was not controlled.
    (B) Sequestrectomy and debridement was done with external fixator applied.

    (C) The external fixator was changed to intramedullary nail with strut bone graft. Radiograph shows partial bone union with good alignment.

    Fig. 3
    (A) The radiograph shows femur proximal shaft comminuted fracture fixated with open intramedullary nailing. The patient showed pus discharge from the fracture site.
    (B) Removal of implant and debridement was performed, and external fixator and antibiotic mixed cement bead was inserted to control infection.

    (C) External fixator was removed, and debridement & reinsertion of antibiotic mixed cement bead was inserted for infection control.

    (D) Last follow up radiograph shows complete bone union with plate fixation and cancellous bone graft.

    Fig. 4
    (A) The picture of 28 year-old-male 6months following initial operation shows nonunion of distal femur. The patient had pus discharge from the fracture site.
    (B) Internal fixator was removed and antibiotic mixed cement spacer was inserted to fill the bony defect of infected nonunion site with steinman pin and antibiotic mixed cement bead in proximal femur.

    (C) After spacer removal and strut bone graft, the radiograph show complete union with posterior angulation of distal femur.

    Fig. 5
    (A) Radiograph of a 45-year-old male shows right pilon fracture with lateral malleolar fracture (open III-b) treated with Ilizarov fixator.
    (B) At 2 months following initial operation, pus discharge and fracture site displacement was observed. Sequestered bone was resected and cement bead was inserted to control infection.

    (C) After infection was controlled, Ilizarov fixator was applied for the lengthening of tibia.

    (D) Radiograph shows complete bone union with good alignment of tibia with ankle joint in fusion state.

    Fig. 6
    (A) Radiographs shows 47-year-old male with left pilon fracture and distal tibio-fbular fracture with initial treatment using Ilizarov fixator.
    (B) At 2 months following operation, pus discharge and displacement of fracture site was observed. Nonviable bone was resected with antibiotic mixed cement bead insertion for infection control and external fixator for stabilization.

    (C) After the infection control, Ilizarov external fixation and corticotomy was done for the lengthening of tibia.

    (D) Tibia lengthening of 15 cm was achieved after 7 months.

    (E) Skin defect was covered with rotational hemisoleus muscle flap and split thickness skin graft.

    (F) Last follow up radiograph shows complete bone union with good alignment.

    References

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