Aseptic Forearm Nonunions Treated by Plate and Opposite Fibular Autograft Strut

Abstract

Forearm nonunion frequently changes the relationship between the radius and ulna and may lead to impairment of forearm function. We propose a new surgical technique for aseptic forearm nonunions combining a fibular cortical autograft strut with a metal plate and a fibular intercalary autograft in cases with a segmental bone defect. We retrospectively reviewed 20 patients with a mean age of 31 years (range, 17-48 years) at the time of surgery. Minimum followup was 12 years (mean, 14 years; range, 12-21 years). There were no intraoperative or postoperative complications. At last followup, all forearm bones had remodeled. The mean visual analog pain scale was 1 (range, 0-3). Forearm function improved; there were no radiographic signs of ankle arthritis at followup. Surgical treatment of aseptic forearm nonunions by combining a massive fibular cortical autograft strut with a plate and associating a fibular intercalary autograft in case of a segmental bone defect led to bone healing, improved forearm function, and a durable outcome with long-term followup.

Treatment Results Of Diaphyseal Forearm Fractures With Dynamique Compression Plate A Retrospective study of 156 Cases.

“…These elements are associated with the following: age and osteoporosis, smoking, high energy trauma and comminuted fractures, open fractures with periosteal stripping and inadequate osteosynthesis. Those factors are confirmed by many authors (17)(18)(19)(20). Technical errors were found in the management of the forearm fractures which explains nonunion that was found in our series, namely: a plate of which the most proximal of the three distal screws appeared in the fracture site, the use of a single pin in the ulna pinning (K-Wire) , little filling and consisting of very fine pins, open fractures treated with external fixation.…”

LCP with autograft in the treatment of adult forearm aseptic nonunions

“…[1,[5][6][7][17][18][19][20] Factors related to fracture (comminution, open fracture, location of the fracture, state of soft tissue), patient (age, smoking, additional diseases), and initial treatment (implant used, surgical technique) have been held responsible for forearm non-union. Debridement of devitalized tissue, removal of failed implant, proper alignment during surgery, and achievement of rotation are the stages to be followed during non-union surgery.…”

“…Although bilateral passing through 4 cortices has been shown to be biomechanically sufficient, [11] most authors advocate passing through 6 cortices on each side of the fracture. [15][16][17][18][19][20][21]26] In each patient, 3.5-mm LCP was used, and fixation was performed by passing through at least 6 cortices on both sides of the fracture. The high rate of union observed following this application suggests that preoperative planning and more stable fixation with the use of locking plates contribute to successful outcome.…”

“…Nicoll et al used corticocancellous grafts for the first time in non-union of the forearm bones, and several other authors have reported results of graft application. [19,24] Ring et al reported successful results with the use of non-vascularized autogenous corticocancellous grafts on defects up to 6 cm in size with atrophic non-union. [32] dos Reis et al reported excellent radiological and clinical results with application of corticocancellous grafts and plates in cases with atrophic and hypertrophic non-union.…”

“…In spite of recently developed surgical techniques and use of modern implants, the results are not fully satisfactory, and debates regarding the necessity of grafting and type of implant to be used continues. [15][16][17][18][19][20][21] In the present study, efficacy of LCP application and autografting in the treatment of aseptic non-union of the adult forearm was retrospectively evaluated from a radiological and clinical perspective.…”