Treatment of diaphyseal non-unions of the ulna and radius

Peter Kloen, Jim K Wiggers, Geert A Buijze, Peter Kloen, Jim K Wiggers, Geert A Buijze

Abstract

Introduction: Non-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.

Method: We 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.

Patients: The 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.

Results: Average 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%).

Conclusion: Our 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.

Figures

Fig. 1
Fig. 1
a Anterior–posterior radiograph of an atrophic radius non-union in a 38-year-old female. She had undergone multiple previous attempts to obtain union at an outside hospital. Notice the protruding pin proximally. b Wide intra-operative exposure (Henry approach), with a 3.5-mm LCP plate on the radius. Intra-operative distraction maintaining radial length was obtained with a temporary external fixator. c, d Treatment consisted of autologous corticocancellous bone grafting and 3.5-mm LCP plate fixation. Radiographs at 15 months follow-up show a healed radius
Fig. 2
Fig. 2
Lateral radiograph showing a successfully treated hypertrophic ulnar non-union in a 38-year-old male. Fixation was obtained by means of a long compression plate-and-(lag)screw. Although this radiograph clearly shows an ulna minus that might have been exacerbated by using compression (shortening the ulna even more), the patient’s wrist and forearm function is normal and he is pain-free at 22 months follow-up

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