Algorithm reconstruction of extremity bony nonunion

IF: internal fixation; EF: external fixation.
* Radiologic signs include hyperplasia of callus, loosening of internal fixation.
¶ Persistent discharge from the fracture site strongly suggests nonunion caused by pyogenic osteomyelitis.
Δ Vascularized bone grafting and bone transport each have advantages and disadvantages. For upper extremity reconstruction, vascularized bone grafting is often chosen rather than bone transport since early weight bearing (the greatest advantage of bone transport) is not needed. However, for surgeons who do not perform microsurgery, bone transport is the better option.
◊ The Masquelet procedure is a two-stage procedure for healing substantial bone defects associated with osteomyelitis without the need for a vascularized bone graft. It involves the use of bone spacer for period of 6 to 8 weeks until induced synovial membrane formation is completed, after which bone grafting is performed.