RESULTS OF BONE-GRAFTING FOR INFECTED TIBIAL NONUNION

Thirty-two patients with infected tibial nonunions were treated, inclu ding 24 men and 8 women whose ages ranged from 21 to 72 years (mean, 4 0 years). Thirty of 32 patients had bone defects <3 cm. Using the Cier ney-Mader classification of osteomyelitis, 11 of 32 (35%) patients wer e Stage 4A, and 21 of 32 (65%) patients were Stage 4B. All patients ha d irrigation, debridement, and stabilization using an external fixatio n device. Twenty-seven (84%) patients had muscle transfers. The time b etween initial debridement and muscle transfer ranged from 3 to 24 day s (mean, 4 days). Bone grafting was performed between 6 weeks and 8 mo nths (mean, 8 weeks) after soft tissue coverage. Patients received int ravenous antibiotics for 2 to 6 weeks (mean, 6 weeks). Twenty patients received anterior grafting, 10 received posterolateral grafting, and 2 received both. Followup times ranged from 12 to 49 months (mean, 28 months). Twenty-nine of the 32 (91%) patients had tibial unions betwee n 3 to 10 months (mean, 5.5 months) after bone grafting. The 3 failed tibias united after posterolateral grafting. Infection was controlled in all 32 patients. Autogenous cancellous bone grafting using infectio n control principles is an effective means to treat infected tibial no nunions.