SURGICAL TREATMENT OF DIAPHYSEAL FOREARM NONUNIONS BY COMBINING PLATE AND OPPOSITE MASSIVE CORTICAL BONE GRAFT

Abstract

INTRODUCTION: Diaphyseal aseptic nonunions are challenging complications in forearm fractures, as length imbalance of radius and ulna impairs severely its function. The aim of this study is to report the results of a series of patients operated on by an original technique.

MATERIAL AND METHODS: 60 patients aged 17–72 years (mean 35) were treated between 1980 and 2000. Ten patients presented radius nonunion, 37 ulna non-union, and 13 nonunion of both bones. Nonunions occurred after conservative treatment in 8 cases, after one surgical procedure of plating or nailing in 47 cases and after 2 or more surgical procedures in 5 cases. Surgical treatment occurred at mean 36 months after the fracture and consisted of freshening the bone and applying a plate and an opposite cortical bone allograft; in 17 cases omologous intercalary bone graft was applied to restore length, axial and rotational alignment. Postoperative treatment consisted of functional bracing associated with intensive rehabilitation of the elbow and wrist beyond clinical and radiographic union. Average follow up was 15±7 years.

RESULTS:. One implant failed due to infection, requiring additional surgery. Mean elbow ROM was 122°±18. Compared with the contralateral arm, mean loss of wrist ROM was 20°±17. Mean loss of forearm rotation was 25°±15. Average healing time was 14±4 weeks X-ray analysis showed bone healing and good osteointegration of the graft in all cases.

DISCUSSION AND CONCLUSION: Combining a plate and an opposite massive cortical bone graft resulted to be a very effective technique for surgical treatment of forearm nonunions.