Infected non-union

In open fractures the rate of infected non-union defects has in recent years decreased due to the increased primary application of external fixation. In spite of this positive state of affairs the condition is still encountered often enough to warrant specific treatment strategies and techniques. In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of infected pseudarthrotic bone and of the diseased surrounding soft tissue, provides mechanical stability in the non-union area and requires effective local treatment of the infection in combination with systemic, target-specific and temporary well-defined antibiotic therapy as well as procedures to improve local circulation. The incorporation of autogenous bone transplants in defects appears to depend on close contact between the transplant and the vascularized receiving site and on the quantity of the transplanted osseous material. A promising alternative method of dealing with extensive bone defects is osteogenesis produced by callus distraction; therefore special attention is given to Ilizarov's ring fixation system. Unstable scar formation demands local muscular flaps or microvascularized free flap transfer, which seems to be superior to other methods.