Treatment of nonunion in neglected long bone shaft fractures by osteoperiosteal decortication

Abstract

In emerging countries, nonunion in the shaft of fractured long bones is common. Patients and methodsIn a 3-year long prospective study, 50 patients (38 men, 12 women) with an average age of 40.9 years (range 17–60) were treated for neglected diaphyseal nonunion an average of 11 months (range 6–48) after the fracture event. The femur was involved 14 times, tibia 22 times, humerus eight times and forearm bones six times. All of these patients had consulted initially with a traditional bone setter at the time of fracture. The surgical procedure consisted of osteoperiosteal decortication followed by repermeabilization of the medullary canal and then internal fixation. Compression plating was used for the humerus, radius and ulna. Nonunion of the middle-third of the femur and tibia was treated by intramedullary nailing and nonunion of the proximal third of the femur with an inverted DCS® screw-plate. Patients were reviewed clinically and with X-rays on postoperative days 21, 45, 90 and 120. ResultsBone union was obtained in under 90 days in the upper limb and under 120 days in the lower limb. No additional grafting was needed. There were only two cases of leg length differences. DiscussionOsteoperiosteal decortication is a reliable technique that leads to predictable, satisfactory results, given the limited materials required to treat long bone nonunion in emerging countries.