Management of an infected nonunion of the long bones is quite difficult and challenging. A staged procedure comprising of radical debridement followed by definitive internal fixation is favored. However, no standard treatment has been established for determining the appropriate waiting period between the initial debridement and the definitive internal fixation. We proposed a management incorporating early definitive internal fixation for infected nonunion of the lower limb.
Thirty-four patients (28 men and six women; mean age, 46.1 years; range, 25–74 years) with infected nonunion of the tibia or femur were included. Initial infected bone resection and radical debridement were performed for each patient in accordance with the preoperative plans. Definitive surgery was performed 2–3 weeks after the resection (4 weeks after flap surgery was required), and the third surgery was performed to fill the bone defect through bone grafting or transport (three-stage surgery). In cases of unplanned additional surgery, the reason for the requirement was analyzed, and radiological and functional results were investigated in accordance with the Association for the Study and Application of the Method of Ilizarov criteria.
Bone union was achieved in 100% of the patients, and treatment was conducted as planned preoperatively in 28 patients (28/34, 82.4%). The mean interval between the primary debridement and the secondary definitive fixation was 2.76 weeks (range, 2–4 weeks). Six unplanned additional surgeries were performed, and the infection relapsed in two cases. The radiological and functional outcomes were good or better in 32 and 31 cases, respectively.
Early definitive surgery can be performed to treat infected nonunion by thorough planning and implementation of radical resection, active response to infection, restoring defected bones, and soft tissue healing through a systemic approach.