War Surgery and Medicine
The occurrence of non-union in war fractures was not uncommon, as could be expected both from the frequent loss of bone and from the often long-continued osteomyelitis. Non-union became less common with the better treatment and more rapid healing of fracture wounds.
With the introduction of penicillin and its damping effect on infection, operative treatment for non-union could be attempted with success at an earlier period, and before the bone at the site of non-union had become sclerosed and its ability to regenerate lessened. The utilisation of cancellous bone chips in the repair of non-union of the jaw led to the use of similar methods in the long bones, but as stability was of great importance during the repair, a combination of a long fixing graft and cancellous bone chips was generally used. The great advantage of using cancellous bone was realised, the denser bone acting almost solely as a temporary splint. Screws were commonly used for fixation of the main graft, though sometimes wedging was employed. The cancellous bone was generally taken from the crest of the ilium. It was recognised that the taking of a large graft from the tibia was prone to weaken the bone seriously, and subsequent fracture was not uncommon in these cases.
Non-union commonly occurred in the humerus, the radius, the ulna, and the tibia. The war has given us fresh knowledge and better means of dealing with the condition.page 286