Combined intramedullary and extramedullary fixation with autogenous bone grafting for the treatment of forearm nonunions with severe bone loss

Abstract

Introduction Nonunions of diaphyseal forearm fractures are uncommon. They are usually associated with either a complex injury or a complication such as infection. As a result, the majorities of nonunions are atrophic and result in a defined bone defect. Bridge plates and bone grafts were used for the treatment of such cases; however, the presence of poor bone quality especially with disuse can decrease the screw purchase and stability of fixation. Combined intramedullary and extramedullary fixation may add to the stability of fixation and improve the rates of success. Aim The aim of this work was to assess the results of treatment of forearm nonunions with severe bone loss using combined intramedullary and extramedullary fixation with autologous iliac crest bone grafting. Patients and methods This study included six patients with forearm nonunions with severe bone loss treated by combined intramedullary and extramedullary fixation with autologous iliac crest bone grafting. The study included three males and three females. Their age ranged from 14 to 47 years (mean: 36.1±12.4 years). The duration of nonunion ranged from 6 to 180 ms (mean: 78±71.5 ms). A total of four (66.7%) cases had been infected previously. The number of previous surgical procedures ranged from 1 to 8 (mean: 3.5±2.5). The forearm was transformed into a single bone in three (50%) cases. Results All nonunions healed satisfactorily. The final pain scale ranged from 0 to 2 points (mean: 1.3±0.8 points). There was a slight limitation in activities of daily living in all points. The hand grip was normal in one patient, slightly weak in four patients, and moderately weak in one patient. Conclusion Combined intramedullary and extramedullary fixation with autogenous bone grafting is a reliable method of treatment of difficult forearm nonunions with significant bone loss.