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.