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Posterior bone-grafting for infected ununited fracture of the tibia.

Twenty-three patients with severe open tibial fractures complicated by established deep infection and delay or failure of union were treated with posterior tibial bone-grafting. This was followed by immediate ambulation in a plaster cast. Tibial union was achieved in all twenty-three patients. Drainage ceased prior to or simultaneously with union in twenty-one patients, including twelve of fourteen patients who had indolent drainage from the anterior compartment of the leg at the time of posterior tibial bone-grafting.

Adolescent↗

Diagnosis of infection in ununited fractures. Combined imaging with indium-111-labeled leukocytes and technetium-99m methylene diphosphonate.

The results of combined scintigraphy in which indium-111-labeled leukocytes and technetium-99m methylene diphosphonate were used were compared with the results of cultures of open bone at 102 sites of delayed union or non-union, to determine the effectiveness of this combination as a preoperative indicator of osteomyelitis. There were twenty-five true-positive, fifty-nine true-negative, eleven false-positive, four false-negative, and three indeterminate interpretations, yielding, for the diagnosis of osteomyelitis, a sensitivity of 86 per cent, a specificity of 84 per cent, an accuracy of 82 per cent, a positive predictive value of 69 per cent, and a negative predictive value of 94 per cent. There were few false-negative scans; false-positive results were most likely at a metaphyseal site adjacent to a joint in which there was post-traumatic arthropathy, at the site of a failed arthrodesis, and at the site of an unstable delayed union or non-union.

Adolescent↗