Judet osteoperiosteal decortication for treatment of non-union
Guyver P et al. – Osteoperiosteal decortication remains a highly effective surgical technique in the management of failed fracture union. The non union scoring system is a reliable predictor of persistent non union after this type of surgery.Methods
- Retrospective analysis was performed from December 2002 to December 2008 of 40 cases in 39 patients of osteoperiosteal decortication for fracture non–union.
- Concurrent stabilisation was with internal fixation only.
- All procedures were performed by one surgeon (MN) using the Judet technique after learning the technique in the originators hospital.
- A preoperative non union scoring system was also used to assess its use in predicting persistent non–union.
- Union was successfully achieved in 36 of the 39 surviving cases (92.3%) after a median delay of 8 months (range 3–47, SD 9.2).
- Twenty–six patients (65%) achieved union following the decortication procedure without subsequent operations.
- Factors such as open fracture and smoking did not have a statistically significant effect on union.
- The mean number of procedures following decortication was 0.68 (range 0–4).
- Metalwork failure occurred in 11 cases (28%), the majority in femoral decortications (n=9, 82%).
- The femur was the site of all persistent non unions in the series.
- Three patients had superficial infections and two had deep infections.
- The pre–operative non union scoring system (0–100) means were noticeably worse for the persistent non union group 42.0 (20–46) compared with the union group 31.0 (range 4–52).