Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon
Part 10 of 12 in Spectrum of Orthopaedic Disorder - Evaluation and Management
Treating Fracture Non-Union and Bone Infection with External Fixators
September 6, 2026
Two related complications came up in Dr. Lamba's case review: fractures that fail to heal properly, and fractures that go on to develop infection in the bone. Both call for the same basic tool, an external fixator, though the surgery around it differs.
When a fracture does not unite
When a fracture fails to unite, the original implant can fail along with it. Dr. Lamba's approach is to remove the old implant, insert a long rod down the length of the bone, and add bone graft material to encourage the bone to finally knit together.
Clearing infection before the bone can heal
Bone infection following a fracture needs an extra step before any reconstruction can begin: every piece of dead, infected bone has to be removed first. As Dr. Lamba put it, the infection keeps recurring for as long as any dead bone is left behind, even if that means leaving a visible gap in the bone afterward. Once the dead bone is cleared, an external fixator is applied to hold the limb in position while new bone forms across the gap.
This article is based on a Jivo Masterclass session conducted by Dr. Rohit Lamba, Consultant, Orthopaedics & Joint Replacement, Artemis Hospital, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rohit Lamba taught doctors across Africa on April 6, 2025.
FROM THE LIVE Q&A
Doctor on the call (name unclear from transcript)
Is there a definitive treatment for arthritis?
Dr. Rohit Lamba
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
Frequently Asked Questions
Which group of patients is hip replacement surgery indicated for?▼
Dr. Lamba outlined four categories. The first is congenital deformity, such as developmental dysplasia of the hip, where the hip is out of the socket from birth. The second is a childhood infection, Perthes disease, or a slipped epiphysis that reshapes the hip and leads to arthritis later in life. The third is avascular necrosis that has reached an advanced, arthritic stage in early adulthood. The fourth is a hip fracture that has not united properly, healing in a poor position that causes arthritis and pain.
Is there a definitive treatment for arthritis?▼
Dr. Lamba answered on the assumption the question was about rheumatoid arthritis, since a network issue had cut off part of the question. In the early stage, before the cartilage is damaged, it can be managed well with disease-modifying antirheumatic drugs (DMARDs); cases that do not respond well can move to biological disease-modifying drugs, but only after full evaluation by an orthopaedic surgeon or rheumatologist. Once the cartilage is already damaged, the definitive treatment is hip replacement, and with current implants a patient can expect to stay pain-free and active for the next 30 to 35 years.
What happens when a fracture does not unite?▼
The original implant can fail. Treatment involves removing it, inserting a long rod down the bone, and adding bone graft material to help it finally knit together.
How is bone infection after a fracture treated?▼
All dead, infected bone has to be removed first, since infection keeps recurring as long as any is left behind, even if that leaves a visible gap in the bone.
What role does an external fixator play in these cases?▼
Once dead bone is cleared, an external fixator holds the limb in position while new bone forms across the remaining gap.
In This Series: Spectrum of Orthopaedic Disorder - Evaluation and Management
- 1.Spectrum of Orthopaedic Disorders
- 2.Understanding the Main Causes of Knee Arthritis
- 3.How Robotic and Computer-Navigated Systems Are Used in Joint Replacement
- 4.Developmental Dysplasia of the Hip: Treating a Childhood Hip Problem
- 5.Perthes Disease: When Childhood Hip Damage Surfaces Years Later
- 6.Avascular Necrosis of the Hip: Causes, Stages and Treatment
- 7.Hip Replacement and Sickle Cell Disease: Why Blood Transfusion Comes First
- 8.When Is Hip Replacement the Right Treatment?
- 9.ACL and Ligament Reconstruction: Grafts and When Surgery Is Needed
- 10.Treating Fracture Non-Union and Bone Infection with External Fixators
- 11.Reconstructing Severe Trauma: Distraction Osteogenesis for Bone and Limb Loss
- 12.Vitamin D Deficiency in Children: When Rickets Requires Corrective Knee Surgery