CURRENT CONCEPTS REVIEW SOUbORNý REfERáT
BackgroundForearm fracture non-unions are uncommon but complex problems that present a significant therapeutic challenge. The forearm is a unique anatomical unit with an important relationship between the radius, ulna, interosseous membrane, elbow and wrist which determines its complex biomechanics and function. Thus, treatment of both acute forearm fractures and non-unions can be distinctly different to that of other long bones. Anatomical restoration of length, alignment, rotation, radio-ulnar articulation and radial bow are essential for enabling the optimal stabilising effects of forearm muscles and interosseous membrane, range of movement, particularly pronation-supination, and overall function with positioning of the hand in space (25,53).Contemporary plate osteosynthesis, specifically using the dynamic compression plate (DCP) and low contact DCP (LC-DCP) developed by the AO group, combined with established techniques of internal fixation have revolutionised the treatment of diaphyseal forearm fractures. This has minimised failure to heal and rates of non-union whilst achieving good to excellent functional outcomes (8,10,22,43,46,53). Forearm fractures treated with plate osteosynthesis demonstrate non-union rates under 5% (8,10,22,46,53) and a target rate of < 2% is stated if fracture fixation is executed with good technique in the compliant patient (8). Consequently, the published evidence for treatment of this problem is lacking (16,26, 32,41,46,57).Non-union of the forearm is also intimately associated with significant pain experience, marked pre-operative functional disability and physical and psychosocial morbidity (3). This review discusses the current concepts and evidence base, aiming to address the controversies and provide recommendations to guide management of this challenging problem in achieving both optimal clinical and patient related functional outcomes.