SURGICAL TREATMENT OF NON-UNION OF LONG BONES

¹ National Center of Reconstructive Surgery, Hópital Foch, Paris

1. The intramedullary nail provides an excellent method of fixation for certain cases of non-union of the long bones. Its advantages for the femur and humerus are particularly striking; it reduces the time of immobilization in a cast to one month, and affords early rehabilitation of the muscles and joints. This is very important, as these patients have already been confined to bed for many months. However, the Küntscher nail must be discarded in all cases with previous deep infection, because of the risk of recurrent infection, as well as in those cases in which a large bone defect is present, especially at the femur or tibia. In addition, it must always be combined with a bone graft, firmly fixed to the fragments by screws.

2. The tibial graft alone is the best method for the tibia (inlay graft) and for the forearm (onlay graft). It must be fixed very firmly. If the onlay method is employed, screws are the best means of fixation (Tables IX and X).

3. The cancellous bone taken from the iliac crest is the best material to fill bone defects, if the fragments are firmly fixed either by a tibial graft (for the tibia or femur) or by an intramedullary nail (for the humerus).

See table in the PDF file

In all cases, the bones must be surrounded by healthy soft tissue, made possible by the excision of the fibrous tissue. This tissue must he replaced, where superficial bones are concerned, by a pedicled skin graft made in a preliminary stage. In the case of deeplying bones, replacement is made in the same stage, by approximating the adjacent muscle tissue.

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