Introduction: Septic non unions are rare and often occurs after an open fracture but they might arise after an inappropriate surgical or medical treatment. Different techniques can be used for the treatment. External fixation has many advantages over other techniques particularly when bone reconstruction and/or plastic surgery are indicated although sometimes more than one surgery is necessary to restore ideal biological and mechanical conditions for healing.

Material and Methods: The authors present their experience in the treatment of 38 septic non unions using a protocol which differentiates the diagnostic and therapeutic approach. External fixation can be used as a single procedure or associated to other surgical procedures in relation to the type and diffusion of the infection.

Results: Bone healing and infection eradication have been obtained in 92% of the cases (35 pts). We had 3 secondary amputations (8%). In the first series of patients screw removal and replacement, for pin track infections, occurred in 40% of the cases while this percentage decreased to 4.3% when HA- coated screws were used.

Conclusions: The treatment of septic non-unions needs a multidisciplinary approach to treat properly both non union and infection of bone and soft tissues. Internal fixation remains a procedure at risk because of the high rate of infection recurrence. External fixation is instead still the safer and more versatile surgical option to treat these pathologies. It nevertheless requests strict diagnostic and therapeutic protocols and a good postoperative organisation in order to shorten the healing time and to minimise the complications.