Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating

Abstract

Background: The treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best. Limiting aspects of this particular anatomic location include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, as well as the risk of elbow and wrist stiffness related to prolonged immobilization. The present study was designed to assess the outcome of autologous bone grafting with compression plating and early functional rehabilitation in patients with forearm fracture non-unions.

LCP with autograft in the treatment of adult forearm aseptic nonunions

“…[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. [33] In a study by Kumar et al, a union rate of 96% following LCP and autograft treatment was reported in patients with atrophic and hypertrophic nonunion of the humerus. [23] Saka et al also reported high rates of union and functional recovery using nails and autografts in cases of forearm non-union.…”

Bone Grafting in Malunited Fractures

“…The advantage of this method is that it preserves the bone length. The disadvantage is its dependence on the synthesis material, since the lower contact between the bone extremities requires the synthesis to be larger (Barbieri et al, 1997;dos Reis et al, 2009;Orzechowski et al, 2007;Reis, 2001). …”

“…In general, bone grafts are indicated in cases where the cause is either purely biological, or biological associated with a mechanical cause. Thus, vascularized and sometimes oligothophic malunited fractures have formal indication for bone grafting (dos Reis et al 2009;Gibson & Loadman, 1948;Haddad & Drez, 1974, Nicoll, 1956). …”

“…Because the forearm is a well-established morphofunctional unit, it is necessary to preserve compatibility of the length between the two long bones. Therefore, we may use a tricortical or a vascularized graft (mainly in gaps larger than 6 cm) in the bone that presents bone tissue loss and/or to associate this procedure with shortening of the other bone (Figure 8) (Barbieri et al, 1997;dos Reis, 2009;Reis, 2001). …”

“…The bone grafts used in these cases are basically (dos Reis et al 2009;Nilsson et al 1986;Piotrowski et al, 2005;Reis, 2001):…”