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Aseptic Forearm Nonunions Treated by Plate and Opposite Fibular Autograft Strut

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

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.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Anderson LD. Compression plate fixation and the effect of different types of internal fixation on fracture healing. J Bone Joint Surg Am. 1965;47:191–208.

    PubMed  CAS  Google Scholar 

  2. Boyd HB. Surgical exposure of the ulna and proximal third of the radius through one incision. Surg Gynecol Obstet. 1940;71:86.

    Google Scholar 

  3. Bronstein AJ, Trumble TE, Tencer AF. The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg Am. 1997;22:258–262.

    Article  PubMed  CAS  Google Scholar 

  4. Christensen NO. Kuntscher intramedullary reaming and nail fixation for nonunion of the forearm. Clin Orthop Relat Res. 1976;116:215–221.

    PubMed  Google Scholar 

  5. Dabezies EJ, Stewart WE, Goodman FG, Deffer PA. Management of segmental defects of the radius and ulna. J Trauma. 1971;11:778–788.

    Article  PubMed  CAS  Google Scholar 

  6. Fernyhough JC, Schimandle JJ, Weigel MC, Edwards CC, Levine AM. Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion Spine. 1992;17:1474–1480.

    Article  PubMed  CAS  Google Scholar 

  7. Grace TG, Eversmann WW. The management of segmental bone loss associated with forearm fractures. J Bone Joint Surg Am. 1980;62:1150–1155.

    PubMed  CAS  Google Scholar 

  8. Han C, Wood MB, Bishop AT, Cooney WP. Vascularized bone transfer. J Bone Joint Surg Am. 1992;74:1441–1449.

    PubMed  CAS  Google Scholar 

  9. Hong G, Cong-Feng L, Hui-Peng S, Cun-Yi F, Bing-Fang Z. Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails. Clin Orthop Relat Res. 2006;450:186–192.

    Article  PubMed  Google Scholar 

  10. Hu R, Hearn T, Yang J. Bone graft harvest site as a determinant of iliac crest strength. Clin Orthop Relat Res. 1995;310:252–256.

    PubMed  Google Scholar 

  11. Ilizarov GA, Kaplunov AG, Degtiarev VE, Lediaev VI. [Treatment of pseudoarthroses and ununited fractures, complicated by purulent infection, by the method of compression-distraction osteosynthesis] [in Russian]. Ortop Travmatol Protez. 1972;33:10–14.

    PubMed  CAS  Google Scholar 

  12. Jupiter JB. Complex non-union of the humeral diaphysis. J Bone Joint Surg Am. 1990;72:701–707.

    PubMed  CAS  Google Scholar 

  13. Moroni A, Caja VL, Sabato C, Rollo G, Zinghi G. Composite bone grafting and plate fixation for the treatment of nonunions of the forearm with segmental bone loss: a report of eight cases. J Orthop Trauma. 1995;9:419–426.

    Article  PubMed  CAS  Google Scholar 

  14. Moroni A, Rollo G, Guzzardella M, Zinghi G. Surgical treatment of isolated forearm non-union with segmental bone loss. Injury. 1997;28:497–504.

    Article  PubMed  CAS  Google Scholar 

  15. Morshed S, Corrales L, Genant H, Miclau T 3rd. Outcome assessment in clinical trials of fracture-healing. J Bone Joint Surg Am. 2008;90:62–67.

    Article  PubMed  Google Scholar 

  16. Muller ME, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation. Techniques Recommended by the AO Group. 2nd Ed. New York, NY: Springer; 1979.

    Google Scholar 

  17. Naimark A, Miller K, Segal D, Kossoff J. Nonunion. Skeletal Radiol. 1981;6:21–25.

    Article  PubMed  CAS  Google Scholar 

  18. Nicoll EA. The treatment of gaps in long bones by cancellous insert grafts. J Bone Joint Surg Br. 1956;38:70–82.

    PubMed  Google Scholar 

  19. Richard MJ, Ruch DS, Aldridge JM 3rd. Malunions and nonunions of the forearm. Hand Clin. 2007;23:235–243, vii.

    Article  PubMed  Google Scholar 

  20. Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB. Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am. 2004;86:2440–2445.

    PubMed  Google Scholar 

  21. Scaglietti O, Stringa G, Mizzau M. Bone grafting in nonunion of the forearm. Clin Orthop Relat Res. 1965;43:65–76.

    Article  PubMed  CAS  Google Scholar 

  22. Scott J, Huskinsson EC. Graphic representation of pain. Pain. 1976;2:175–184.

    Article  PubMed  CAS  Google Scholar 

  23. Shelton WS, Sage FP. Modified Nicoll-graft treatment of gap nonunions in the upper extremity. J Bone Joint Surg Am. 1981;63:226–231.

    PubMed  CAS  Google Scholar 

  24. Spira E. Bridging of bone defects in the forearm with iliac graft combined with intramedullary nailing. J Bone Joint Surg Br. 1954;36:642–646.

    PubMed  Google Scholar 

  25. Szabo RM, Weber SC. Comminuted intraarticular fractures of the distal radius. Clin Orthop Relat Res. 1988;230:39–48.

    PubMed  Google Scholar 

  26. Thompson JE. Anatomical methods of approach in operations on the long bones of the extremities. Ann Surg. 1918;68:309–329.

    Article  PubMed  CAS  Google Scholar 

  27. Van Dijk CN, Tol JL, Verheyen CC. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med. 1997;25:737–745.

    Article  PubMed  Google Scholar 

  28. Weber BG, Cech O. Pseudoarthrosis. Vienna, Austria: Hans Huber; 1976.

    Google Scholar 

  29. Williamson DM, Copeland SA, Landi A. Pseudoarthrosis of the radius treated by free vascularized bone graft. J Hand Surg Br. 1989;14:221–225.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Olivia Faldini for help in clinical evaluation of the patients during followup.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Istituto Ortopedico Rizzoli, Segreteria Università, University of Bologna, Via GC Pupilli 1, 40136, Bologna, Italy

    Cesare Faldini MD, Stavroula Pagkrati MD, Matteo Nanni MD, Shay Menachem & Sandro Giannini MD

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  1. Cesare Faldini MD
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  2. Stavroula Pagkrati MD
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  3. Matteo Nanni MD
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  4. Shay Menachem
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  5. Sandro Giannini MD
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Corresponding author

Correspondence to Cesare Faldini MD.

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Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Faldini, C., Pagkrati, S., Nanni, M. et al. Aseptic Forearm Nonunions Treated by Plate and Opposite Fibular Autograft Strut. Clin Orthop Relat Res 467, 2125–2134 (2009). https://doi.org/10.1007/s11999-009-0827-5

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  • DOI: https://doi.org/10.1007/s11999-009-0827-5

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