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.

Aims: To compare two protocols of early mobilisation for minimally displaced radial head fractures through a single-blinded, prospective randomised trial. Methods: Sixty patients were randomly allocated to either immediate active mobilisation or 5-day delay before active mobilisation was commenced. Patients were reviewed at 7 days, 4 weeks and 3 months after injuries. A blinded observer assessed each patient. Results: All fractures united by the third month. At the end of 7days, the mobilisation group had less pain (VAS 6 vs 7.6, p=0.002); greater ßexion (mean 112û vs 98û, p=0.0004); greater strength in supination (p< 0.001) and better elbow function (Morrey Score 54 vs 43, p=0.005). By the fourth week, both groups were comparable in all parameters and improvement continued into the third month. Mean limit of extension at the third month were 2.3û in the immediate mobilisation group and 1.8û in the delayed group (NS). All had excellent function on the basis of the Morrey Score. Conclusions: Immediate mobilisation did not adversely affect the outcome; the patients had less pain and better elbow function at one week post-injury. Pain, ranges of movement and function were similar by the fourth week post-injury.