Elimination of infection by early and frequent surgical intervention is most important in the treatment of infected compound fractures. Early coverage of the wound aids materially in two ways: First, as soon as the wound has been covered with skin and scar tissue, proliferation ceases; thus there is less soft-tissue damage and less joint stiffness. Second, bone-grafting can be done at an earlier date, due to the fact that infection has been eliminated early.
The soft-tissue coverage must be adequate before grafting is done. Unless split-skin grafts have considerable subcutaneous fat and muscle between them and the bone, they will not withstand the strain when exposure is made through them. Therefore, pedicle grafts must be used in many instances to replace poor skin.
With the use of penicillin, bone-grafting can be done three months after the cessation of drainage, if all other factors are favorable.
The type of bone graft varies with the circumstances. Whenever possible, iliac grafts should be used, since they are usually applied easily and replaced rapidly. Foreign material for internal fixation is necessary only when the fragments and the graft will not remain in position without internal fixation.
Iliac grafts aid materially in arthrodesis, particularly of the wrist, knee, and subtalar joints, and the small joints of the hand. The authors have had no experience in employing iliac bone in the stabilization of other joints.