Localized, full-thickness osteomyelitis (type III) may be associated with a ununited fracture. Surgical excision back to bleeding bone may remove so much cortex that the structural integrity of the bone is compromised and pathological fracture is a risk. Mechanical protection will then be necessary, using an external fixator. More complex options for soft-tissue closure (local or free flaps) may be required.
Bone grafting is often necessary, but should be delayed until soft-tissue coverage is healed and stable, and the infection has healed.