• Diren Arsoy, Johanna C E Donders, Laura J Kleeblad, Andy O Miller, Michael W Henry, Davis S Wellman, and David L Helfet.
• Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY.
• J Orthop Trauma. 2018 Feb 1; 32 Suppl 1: S35-S39.

ObjectiveTo evaluate the outcomes of a single-stage surgical protocol to treat a presumed aseptic long-bone nonunion with positive intraoperative cultures obtained at the time of surgery.DesignRetrospective comparative series.SettingOrthopaedic specialty hospital.Patients And MethodsWe retrospectively identified 77 patients with long-bone nonunions thought to be aseptic preoperatively, which grew bacteria from cultures obtained at the time of index nonunion surgery.InterventionFifty (65%) patients underwent open debridement of the nonunion site followed by surgical stabilization through plates and screws. Twenty-seven (35%) patients underwent exchange nailing with canal reamings used for cultures.Main Outcome MeasurementRate of radiographic union, time to clinical and radiographic union, nonunion rate after index nonunion surgery, and final union rate after revision procedures.ResultsOsseous union after the index nonunion surgery was achieved in 84% of the patients (65 of 77). Time to clinical union was 6.3 months (range, 1-24 months), and time to radiographic union was 7.4 months (range, 2-24 months). Eighteen percent (14 of 77 patients) did not heal after the index nonunion surgery and required additional surgeries. The final union rate after revision surgery was 99% (76 of 77 patients).ConclusionsEighty-four percent of presumed aseptic nonunions of long-bone fractures with positive intraoperative cultures fully healed after a single-stage surgical protocol and long-term antibiotic when appropriate. When patients are diagnosed with a subclinical infected nonunion, they should be counseled about the higher likelihood of reoperation, but in most cases can expect excellent union rates after 1 additional surgery.Level Of EvidencePrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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