Traitement de la pseudarthrose diaphysaire de l’avant-bras : greffe osseuse autologue iliaque corticospongieuse et fixation par plaque verrouillée

Abstract

IntroductionStudies conducted on forearm bone diaphysis nonunion are limited due to the rarity of this condition. The present study aimed to evaluate the outcome of our technique using autologous iliac corticocancellous bone graft fixed by locking plate system for the forearm bone diaphyseal nonunion without infection. Patients and methodsWe treated eight patients with nonunion of radial or ulnar shaft fracture (four men, four women) aged 38 years (range: 18–52 years) on average. The average follow-up period was 18 months (range: 12–24 months). In our technique, we applied the locking plate to the diaphyseal bone fragment, before grafting the bone block to the nonunion site. After excision of sclerotic ununited bone, the autologous iliac corticocancellous bone was grafted to the defect and fixed with single locking screw. Pain, grip strength, and disabilities of the arm, shoulder, and hand (DASH) score were measured and compared before and 12 months after the surgery. Radiographs were taken at each follow-up, and the time of bony union was determined. ResultsThe mean time to radiological union was 4.2 months (range: 3–6 months), and bony union was achieved in all cases within 6 months. All measured values, visual analog scale, DASH score, and grip strength, were significantly improved at 12 months after surgery (p<0.05). No minor/major complications including infection, nonunion, or malunion were reported. ConclusionsLocking compression plate fixation and autologous iliac corticocancellous bone grafting with a holding locking screw appears to be a reliable primary procedure for nonunion of the forearm diaphyseal fracture without infection. Level of evidenceIV; Therapeutic study.