Treatment of infected nonunion of forearm bones by ring external fixator

Abstract

Background An infected nonunion in the diaphysis of the radius and ulna is a difficult problem to solve. Several methods and techniques have been suggested including repeated debridement followed by internal fixation and bone graft or through vascularized free tissue transfer. The results of treating infected nonunions of the forearm bones by a two-stage treatment strategy using the Ilizarov ring external fixators are reported. All cases were treated at the Menoufia University Hospital. Patients and methods Nine patients with an average age of 49 years (range, 45–52 years) with infected nonunions of one or both bones of the forearm were treated at this unit between August 2005 and September 2007. A staged protocol of treatment was adopted in case of active infection. The first stage included radical debridement of the site of nonunion followed by an interval of antibiotic treatment. The final stage included application of a ring external fixator. Three patients had nonunions of both the radius and ulna, another two had nonunion of the ulna, and four patients had nonunion of the radius. Autogenous cancellous bone graft was used in all patients to treat the defect caused by the nonunion and surgical resection. Patients were evaluated by The Disabilities of the Arm, Shoulder and Hand score. Results The mean period in the external fixator was 22.6±3 weeks (mean±SD). All fractures achieved full bony union with no evidence of deep infection at last review (mean follow-up period 34 months; range, 24–47), as well as vascular or neural compromise. The mean The Disabilities of the Arm, Shoulder and Hand score improved from 90.5 preoperatively to 41.4 postoperatively (P Conclusion Staged treatment first involves radical debridement of infected bone and soft tissue, which allows eradication of infection. Bone defects can be dealt with through distraction osteogenesis, segment transport, or bone grafts in conjunction with using ring external fixators. The Ilizarov external fixator can be used to overcome bone defects and soft tissue contractures in the forearm, but special expertise in the technique and knowledge of the cross-sectional anatomy of the forearm are essential.