Introduction: The concept of osteoperiosteal decortication for the treatment of fracture non-union and mal-union was introduced by Judet in the early 1960’s. Over 1000 cases have been treated with a union rate of 80 – 90%.

Methods: A review of the clinical notes and plain radiographs was carried out on 21 patients who underwent osteoperiostal decortication between 2002 and 2004. There were 11 male and 9 female patients with 14 femoral, 5 tibial and 2 humeral fractures. 18 patients had non unions and 3 patients malunions. The mean time from fracture to surgery was 8.2 months for the non-unions (range 6 to 16 months) and patients had previously had a mean of 1.8 procedures (range 0 to 4) prior to the index decortication procedure.

Results: 19 patients progressed to union (90%). 9 patients had complications (43%). There were 6 failures of fixation requiring revision surgery and 4 deep infections (2 of which proceeded to amputation). In 4 patients supplementation of the decortication with bone graft or BMP was performed.

Discussion: This series represents the learning curve of the senior surgeon using this technique.

In the treatment of complex non-unions or malunions, the use of osteoperiosteal decortication can achieve a union rate of 90%. However there are high complication rates although the complications are usually salvageable. In this series the infection rate in the distal tibial was noted to be especially high with 3 out of the 4 infective complications being in the tibial fractures.