Die infizierte Pseudarthrose

Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skintraction, flap surgery, bone shifting, etc.). Out of 71 infected non unions, treated by radical resection and bone segment transport, healing rate without recurrence of infection was 94%, in 3 additional patients (4%) amputation was performed. For bone fragment fixation, a non devastating implant, like external fixateur, is preferred. To close the wound, the law of avoiding a dead space is used. Defects are closed by muscle flaps, by fragment shortening or by a antibiotic spacer temporarily. The skin is closed by skintraction techniques or with flap surgery. After soft tissue healing, small bone defects are filled by autografts, defects of more than 3–4 cm with transported segments. Previous limb shortening to close bone defects, with a lengthening later in a ``healthy'' region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.