A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions: a review of outcomes

J Orthop Trauma. 2013 Oct;27(10):582-6. doi: 10.1097/BOT.0b013e31828b76f2.


Objective: To review the results of a single-stage treatment protocol for presumptive aseptic diaphyseal nonunion with a well-healed wound and no infection history.

Design: Retrospective comparative study.

Setting: Tertiary referral center.

Patients and methods: We retrospectively reviewed all presumptive aseptic diaphyseal nonunions treated by a single-stage protocol. There were 104 patients who met the inclusion criteria. Eighty-seven patients were available for follow-up through to complete healing (83.7% follow-up rate).

Intervention: The protocol entails withholding preoperative antibiotics, removing the implant, performing open debridement or canal reaming, taking 5 cultures of the nonunion site or canal reamings, followed by antibiotic administration, and revision open reduction and internal fixation or exchange nailing. If intraoperative cultures are positive, long-term antibiotics are begun specific to organism sensitivities.

Main outcome measurements: To analyze the rate of positive cultures and to compare the rate of secondary surgery to promote healing in positive and negative culture groups.

Results: Intraoperative cultures were positive in 28.7% (25/87) of patients with complete follow-up. The overall rate of secondary surgery for persistence of nonunion was 12.6% (11/87). In patients with positive intraoperative cultures, rate of secondary surgery was 28% (7/25) versus 6.4% (4/62) in the group without positive intraoperative cultures (P = 0.01).

Conclusion: A single-stage treatment protocol for presumptive aseptic diaphyseal nonunions was effective in obviating further revision surgery in 93.6% of truly aseptic cases and in 72% of positive culture cases and is still employed at our institution.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Diaphyses
  • Female
  • Fracture Fixation, Internal / statistics & numerical data*
  • Fracture Healing / drug effects*
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / surgery*
  • Fractures, Malunited
  • Humans
  • Male
  • Middle Aged
  • New York / epidemiology
  • Premedication / statistics & numerical data
  • Prevalence
  • Prosthesis-Related Infections / epidemiology*
  • Prosthesis-Related Infections / prevention & control*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome


  • Anti-Bacterial Agents