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Journal of Bone and Joint Surgery, 1947;29:946-960.
© 1947 by The Journal of Bone and Joint Surgery, Inc

TREATMENT OF UNUNITED FRACTURES BY ONLAY BONE GRAFTS WITHOUT SCREW OR TIE FIXATION AND WITHOUT BREAKING DOWN OF THE FIBROUS UNION

DALLAS B. PHEMISTER M.D.1

1 Department of Surgery of the University of Chicago

1. Ununited fractures of the shaft in which the fragments are in acceptable position have been treated by the application of one or two large bone grafts to a denuded level surface of the cortex across the fracture site, without fixation of graft to fragments with screws or ties, and usually without removal of the fibrous intermediary callus.

2. The grafted bone is held in position by the periosteum and soft parts sutured tightly over it; the fragments are adequately fixed by the remaining callus and attached periosteum, and by the plaster dressing.

3. The graft becomes solidly attached to the fragments, the inteimediary callus ossifies, and bony union is established in a high proportion of cases, with a low incidence of infection. There has been no instance of fracture of the graft.

4. If there has been infection of the fracture which has already healed, it is possible to use this technique relatively soon after healing by placing the incision in healthy tissue away from tile scar and applying the graft across the fracture line on the opposite side of the shaft. In this way the period of disability may be shortened by several weeks or months.

5. The results of the operation demonstrate the falsity of the teaching that, in order to obtain hotly union of this type of fracture, it is necessary to remove the intermediary and medullary callus and to fix rigidly the graft to the fragments.

6. The operation is short, simple, and suitable for a majority of ununited fractures of the shaft. By this operation, the use of screws, plates, and wire is largely avoided.


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