Treatment of diaphyseal non-unions of the ulna and radius

Abstract

IntroductionNon-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation.MethodWe retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975–2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed.PatientsThe study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues.ResultsAverage follow-up time was 75 months (range 12–315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%).ConclusionOur results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

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.…”

Biomechanical Causes of Fracture Non-union after Diaphyseal Forearm Fracture Fixation: an in Silico Analysis. Case Study

“…The most important factors contributing to fracture non-union are be lieved to include extensive tissue laceration, deep tissue contamination at the fracture site with cutaneous or en vironmental flora, impaired blood supply, meta bolic diseases, particularly abnormal calcium metabolism, impaired immune responses, infectious and neoplastic diseases, chemotherapy, prolonged antibiotic therapy, steroid therapy, and damage to mesenchy mal lineage precursor stem cell [6,8,9,10,11,12,13,14,15]. Another important factor contributing to non-union in forearm bone shaft fractures is fixation instability and disturbed "biomechanical silence" within the forearm bone shafts resulting from the action of pronators from the anterior forearm muscle group, mainly the pronator teres, pronator quadratus and flexor carpi radialis, the radial part of the flexor ramienia, głównie mięśnia nawrotnego obłego i nawro tnego czworobocznego oraz mięśni zginacza promieniowego nadgarstka, promieniowej części zginacza powierzchownego palców i promieniowej części zginacza głębokiego palców [16,17,18,19,20,21,22]. Z omawianych czynników sprzyjających zaburzeniu zrostu w tym przypadku, mieliśmy do czynienia poza przebytą sterydoterapią, z obciążeniem przewlekłym nikotynizmem, zaburzeniami gospodarki wapniowej oraz kinezyterapią w zakresie przekraczającym wytrzymałość zespolenia, przy istniejących już pierwotnie, tj.…”

“…U pacjenta stwierdzano więc m.in. przewagę wymiarów szerokościowych nad podłuż-nymi, szeroką klatkę piersiową, grube kończyny, a także dłonie i stopy, szeroką miednicę, jak również digitorum superficialis, and the radial part of the flexor digitorum profundus [16,17,18,19,20,21,22]. In our case, the factors contributing to fracture nonunion included a history of steroid therapy, chronic tobacco use, abnormal calcium metabolism, and kinesiotherapy exceeding the resistance of the fixation in a patient with pre-existing, i.e.…”

Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?

“…Modern fixation techniques with application of the AO principles in forearm fractures have been shown to be relatively secure to achieve healing. Large series have reported nonunion rates below 5 % [16][17][18][19]. Enhancement of healing of a long bone fracture nonunion is a multifactorial process and it depends on the type of nonunion.…”