Abstract
BackgroundThe treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best. Limiting aspects of this particular anatomic location include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, as well as the risk of elbow and wrist stiffness related to prolonged immobilization. The present study was designed to assess the outcome of autologous bone grafting with compression plating and early functional rehabilitation in patients with forearm fracture non-unions.MethodsProspective follow-up study in 31 consecutive patients presenting with non-unions of the forearm diaphysis (radius, n = 11; ulna, n = 9; both bones, n = 11). Surgical revision was performed by restoring anatomic forearm length by autologous bone grafting of the resected non-union from the iliac crest and compression plating using a 3.5 mm dynamic compression plate (DCP) or limited-contact DCP (LC-DCP). The main outcome parameters consisted of radiographic bony union and functional outcome, as determined by the criteria defined by Harald Tscherne in 1978. Patients were routinely followed on a short term between 6 weeks to 6 months, with an average long-term follow-up of 3.6 years (range 2 to 6 years).ResultsRadiographically, a bony union was achieved in 30/31 patients within a mean time of 3.5 months of revision surgery (range 2 to 5 months). Clinically, 29/31 patients showed a good functional outcome, according to the Tscherne criteria, and 26/31 patients were able to resume their previous work. Two postoperative infections occurred, and one patient developed a persistent infected nonunion. No case of postoperative failure of fixation was seen in the entire cohort.ConclusionRevision osteosynthesis of forearm nonunions by autologous iliac crest bone grafting and compression plating represents a safe and efficacious modality for the treatment of these challenging conditions.
Highlights
The treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best
We evaluated the long-term radiological and clinical outcome of 31 consecutive patients treated by autologous bone grafting and compression plating for fracture-nonunions of the forearm
The standardized treatment concept (Figure 1) consisted of resection of the forearm nonunion, autologous bone grafting with a tricortical graft from the iliac crest with anatomic restoration of the foreram length, as determined by intraoperative fluoroscopy assessment of the adjacent joints, and compression plating using a stainless steel small fragment (3.5 mm) dynamic compression plate (DCP) or limited-contact DCP (LC-DCP)
Summary
The treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best Limiting aspects of this particular anatomic location include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, as well as the risk of elbow and wrist stiffness related to prolonged immobilization. Nonunions of the radius and ulna shaft cause a severe anatomic and functional impairment, related to disturbance of the interosseous membrane and dysfunction of the adjacent joints, elbow and wrist [3,4,5,6] These demanding nonunions require the surgical correction to restore the anatomy of the forearm and to improve function [1,7]. Free fibula transfer flaps have been advocated as a means to restore anatomic length and ensure bony union [11,12]
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