A Modification of Internal Bone Transport Method for Reconstruction of Nonunion of Forearm

Abstract

Background: Defects of bone and soft tissue occur frequently after high-energy trauma, infections, and tumor resection. Treatment options are limited and outcomes are controversial in nonunion. Classical reconstruction methods are challenging. We describe a method of internal bone transport for treatment of complicated nonunion of the forearm. This method permits axial and internal bone transport without harming the distorted and complex neurovascular anatomy or soft-tissue envelope. Materials and Methods: Five patients (mean age, 27 years) with defect nonunion (3 ulna, 2 radius) were treated. Mean preoperative defect size was 36 mm, mean shortening was 14 (0–30) mm, and the extent of surgical resection was 24 (20–40) mm. Total bone loss due to defect, resection, or shortening was 74 mm. According to Paley classification, two of the patients had B1, and three had B3 defect nonunion. This study treats defect nonunion of the forearm using an internal bone-transport method. Our method involved cannulated screws, a cerclage wire, and a circular fixator being used in combination. When transportation was completed, internal fixation of the docking site with a plate and screws was done, with bone grafting after fixator removal. Bone healing and functional outcomes were assessed with radiographs and disabilities of the arm, shoulder, and hand (DASH) scores, respectively. Results: Mean followup was 67.6 months. Solid osseous union and functional improvement were achieved in all cases. Mean bone loss was 66 mm, mean fixator time was 131.8 days, the lengthening index was 1.3 days/mm, and the fixator index was 2.1 days/mm. DASH score was 82.2 before treatment and 15.36 after treatment. Conclusions: Using our method, internal bone transport and progressive axial docking of defects can be done with minimal effects on surrounding neurovascular arrangements and soft tissues. Size of fixators can be decreased and formation of painful scar tissue can be avoided.

Advances in the Application of Bone Transport Techniques in the Treatment of Bone Nonunion and Bone Defects

“…Bone transport techniques offer an effective solution to these problems. Demir et al 13 described an internal bone transport method for managing complex forearm bone discontinuities which allowed for axial and internal bone transport without damaging the intricate neurovascular anatomy or compromising the integrity of the soft tissue envelope. Their study encompassed five patients (mean age: 27 years) who presented with osseous nonunion of upper extremity bones (three ulna, two radius) and were successfully treated.…”

“…Bone transport techniques offer an effective solution to these problems. Demir et al 13 . described an internal bone transport method for managing complex forearm bone discontinuities which allowed for axial and internal bone transport without damaging the intricate neurovascular anatomy or compromising the integrity of the soft tissue envelope.…”

Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making

“…Eleven publications reported on the use of bone transport to reconstruct 82 forearm bone defects [33,34,35,36,37,38,39,40,41,42,43]. The majority of cases (n = 76, 91%) were performed for defects post-osteomyelitis debridement and all cases used external fixation for stabilization.…”

“…The majority of cases (n = 76, 91%) were performed for defects post-osteomyelitis debridement and all cases used external fixation for stabilization. One article by Demir et al reported their results of five patients who underwent forearm transport with an external fixator-based bone transport pulley system, similar to a cable transport apparatus [33,50]. Bone transport showed the highest complication rate of all reconstruction modalities although most of these (22/36, 61%) were superficial pin site infections.…”

“…A total of 184 individuals across 31 publications underwent reconstruction of a defect of a single forearm bone [4,6,8,9,10,11,14,16,17,18,19,20,21,22,25,26,28,31,33,35,36,38,39,40,41,42,43,48] (Table 3). Bone transport and the induced membrane technique were employed to reconstruct defects with mean sizes of 44.3 mm and 46.8 mm respectively.…”