DOI: https://doi.org/10.36347/sasjs.2026.v12i10.001

Pages: 800-811

Background: Septic non-union of the leg couples two mutually reinforcing obstacles: failure of bone healing and persistence of a bone infection. The tibia, subcutaneous over most of its length and poorly covered distally, is the long bone most exposed to this complication after high-energy open fracture. Management is long, iterative and functionally hazardous, and no single reconstruction technique has achieved consensus. Objectives: To describe the epidemiological, clinical, radiological and microbiological profile of septic tibial non-union in a Moroccan university department, to detail the staged treatment protocol applied, and to assess bone and functional outcomes against recent international series. Methods: A retrospective single-centre study was conducted in the Department of Orthopedic and Trauma Surgery A, Mohammed VI University Hospital, Marrakech, over five consecutive years (January 2011 – December 2015). All patients with post-traumatic septic non-union of the leg treated and regularly followed in the department were included; aseptic non-unions, patients lost to follow-up, self-discharges and incomplete records were excluded. Treatment followed a staged protocol: radical debridement with culture-directed antibiotic therapy, external fixation, then delayed osteogenic reconstruction with soft-tissue coverage when required. Outcomes were graded with the ASAMI bone and functional criteria. Results: Fifteen patients were analysed among 704 leg fractures treated over the period (incidence 2.13%). Mean age was 41.1 years (18–70) and the sex ratio 4:1 (12 men, 3 women). Road traffic accidents accounted for 80% of injuries; the index fracture was open in 13 patients (86.6%), including six Gustilo type III, and external fixation had been the primary osteosynthesis in 86.6%. Mean interval to non-union was 12.1 months (7–24). Atrophic non-union predominated (8 cases, 53.4%) and bone loss was present in nine patients (60%). Cultures were positive in eight cases o