One bone forearm for massive gap nonunion of distal radius: Our experience and literature review

Abstract

Background: Large defect or massive gap of nonunion distal radius is a rare entity but not uncommon. It usually presents with manus valgus deformity with a disability and difficult to treat. Due to the extensive gap with surrounding soft tissue scarring, the usual method of gap grafting may not be feasible in these cases. In such cases, the creation of one bone forearm has been found to be a sound and excellent method of treatment. The purpose of this paper is not only to present the results of 5 patients of massive gap nonunion of the distal radius treated by one bone forearm but also to review the relevant literature. Materials and Methods: Five cases of posttraumatic massive gap nonunion of radius were treated by the creation of one bone forearm in the past 8 years. The male-to-female ratio was 4:1 with age ranging from 16 years to 35 years. In all cases, ulnar transposition and fixation in the neutral rotation were done to create one bone forearm. Three cases underwent monoaxial distraction of distal radius to correct distal radio-ulnar joint prior to the definitive procedure of one bone forearm. Results assessed by clinico-radiological evaluation. Finally, literature related to the treatment of such cases were searched by Google search, and systematic review on the subject was done. Results: The follow-up period ranges from 4 to 8 years with an average of 4.5 years. According to clinico-radiological evaluation, one patients came out with excellent result and the remaining 3 had a good result. In toto, all five patients had good functional outcomes. Conclusions: To produce “one bone forearm” for massive gap nonunion of the distal radius is not an outdated but still a dependable, effective, and economical procedure with lesser complication, good outcome, shorter hospital stay, and easier postoperative maintenance.