Cavitary osteomyelitis treated by fragmentary cortical bone transportation.

Fragmentary cortical bone transportation can be used to fill large gaps in chronic cavitary osteomyelitis when standard techniques have failed. A low-energy corticotomy can create a loose fragment of cortex with periosteal attachments and surface blood supply still intact. This "vital" fragment can be gradually pulled across a defect within a bone to restore the integrity of the bone segment by distraction osteogenesis. The biologic principles for successful distraction osteogenesis by this innovative technique are illustrated in a 41-year-old man with chronic cavitary (150 cc) (four years) osteomyelitis refractory to multiple debridements, Papineau grafting, gentamicin beads, and tricalcium phosphate.