Management of infected nonunion of long bones: The last decade (1996-2006)

Infected nonunion is one of the most challenging orthopaedic complications to manage. There is considerable morbidity associated with infected nonunion. There is significant impact on the life of the patient; social, financial, physical, and mental. Infected nonunion may be a limb-threatening complication. Significant progress has been made in the management of infected nonunion in the last decade. There are clear guidelines for pre-operative evaluation and treatment strategy. The recommended strategy is the 'infection-elimination first' strategy. This strategy involves two steps: control of infection by local radical debridement of dead tissue followed by reconstruction. There are four operative techniques (with considerable overlap among them) which have been used in the past decade: Ilizarov, intramedullary devices with or without the use of external fixator, free tissue transfer, and in situ reconstruction. Bone results are, in general, better compared to functional results. Overall, the outcome following treatment of infected nonunion are good to excellent. (c) 2007 Elsevier Ltd. All rights reserved.