The treatment of non-union following fractures has always been a difficult surgical problem. If the non-union follows a compound fracture, the problem becomes more complicated because of the increased risk of a postoperative infection. Experience has demonstrated that, with the proper use of chemotherapy, especially its local use in wounds, the number and severity of postoperative infections can be decreased. With this aid, severe non-unions following compound fractures can be bone-grafted with greater chances of success than formerly.
The experience in this Clinic and the published reports of Henderson, Campbell, and Speed have convinced the writer that the majority of non-unions are best treated by the onlay bone graft as recommended by these authors. If the non-union presents unusual difficulties, such as congenital pseudarthrosis, non-unions near joints, poor quality of bone because of previous infection or osteoporosis, or failures following ordinary methods of bone-grafting, the single graft may not be sufficient. Under such conditions the surgeon may be wise to use the dual graft, as the chances for union are greater.
Where large defects are present in the bones of the lower extremity, it is probably best to shorten the extremity sufficiently to employ a single or a dual onlay graft. Large defects in bones of the upper extremity can often be bridged with fibular grafts. This is especially true where the defect involves one of the bones of the forearm.