FOREARM BONE TRANSPORT FOR INFECTED NON-UNION: A REVIEW

Abstract

Introduction: Infected non-union in the forearm is a rare and challenging situation. It can result in persistent deformity, shortening, bone loss, joint stiffness and disability. Secondary procedures are often required for correction of bone defects and deformity. Bone transport may be the only realistic method of treatment.

Case presentation: 56-year-old gentleman referred with an infected non-union of left distal radius. He underwent bone debridement with ilizarov frame application for distraction osteogenesis. After a period of one month, a longitudinal transport wire was inserted through the distal segment to the proximal segment and distraction was carried using this wire. This was supplemented by iliac crest bone graft and OP-1 substitute at docking stage. The frame was removed at 18 months, following which he sustained a refracture. ORIF with bone graft was performed. Finally a good consolidation was achieved. There was about 50% loss in pronation and supination and about 15 degrees short of full extension at the final followup.

Another 57-year-old gentleman referred for an infected non-union of the ulna with a severe bone defect. He was treated with a TSF application and corticotomy for distraction osteosynthesis. There has been a satisfactory progress in the bone transport and recently underwent a docking procedure with bone graft insertion.

Discussion: Post traumatic infected non-union with segmental bone defect in the forearm can be successfully managed with bone transport. Unlike tibia, where this procedure is commonly done, forearm bones have a complex soft tissue envelope which can rule out the use of external transport, especially in the radius. We found the longitudinal wire technique useful for transport of radius. Internal fixation can be used to salvage initial failures, provided that infection and substantial bone defects have been eliminated. This treatment is intensive and difficult for patient and surgeon.