NYMC Faculty Publications
A Single-Stage Treatment Protocol for Presumptive Aseptic Diaphyseal Nonunions: a Review of Outcomes.
Author Type(s)
Faculty
DOI
10.1097/BOT.0b013e31828b76f2
Journal Title
Journal of Orthopaedic Trauma
First Page
582
Last Page
586
Document Type
Article
Publication Date
10-1-2013
Department
Orthopedic Surgery
Abstract
OBJECTIVE: To review the results of a single-stage treatment protocol for presumptive aseptic diaphyseal nonunion with a well-healed wound and no infection history.
DESIGN: Retrospective comparative study.
SETTING: Tertiary referral center.
PATIENTS AND METHODS: We retrospectively reviewed all presumptive aseptic diaphyseal nonunions treated by a single-stage protocol. There were 104 patients who met the inclusion criteria. Eighty-seven patients were available for follow-up through to complete healing (83.7% follow-up rate).
INTERVENTION: The protocol entails withholding preoperative antibiotics, removing the implant, performing open debridement or canal reaming, taking 5 cultures of the nonunion site or canal reamings, followed by antibiotic administration, and revision open reduction and internal fixation or exchange nailing. If intraoperative cultures are positive, long-term antibiotics are begun specific to organism sensitivities.
MAIN OUTCOME MEASUREMENTS: To analyze the rate of positive cultures and to compare the rate of secondary surgery to promote healing in positive and negative culture groups.
RESULTS: Intraoperative cultures were positive in 28.7% (25/87) of patients with complete follow-up. The overall rate of secondary surgery for persistence of nonunion was 12.6% (11/87). In patients with positive intraoperative cultures, rate of secondary surgery was 28% (7/25) versus 6.4% (4/62) in the group without positive intraoperative cultures (P = 0.01).
CONCLUSION: A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions was effective in obviating further revision surgery in 93.6% of truly aseptic cases and in 72% of positive culture cases and is still employed at our institution.
Recommended Citation
Amorosa, L., Buirs, L., Bexkens, R., Wellman, D., Kloen, P., Lorich, D., & Helfet, D. (2013). A Single-Stage Treatment Protocol for Presumptive Aseptic Diaphyseal Nonunions: a Review of Outcomes.. Journal of Orthopaedic Trauma, 27 (10), 582-586. https://doi.org/10.1097/BOT.0b013e31828b76f2
