The number of patients that was treated yearly for a non-union of the forearm declined during that period for two reasons. On average, 21 patients per year were treated for diaphyseal fractures of the forearm. They were extracted from an AO-database into which all patients for fracture care at our hospital were entered during that time. We present their uniform surgical approach, their functional results and rates of union as well as additional surgery and complications.Īll patients treated in our centre for diaphyseal forearm non-unions during the 24-year period between 19 formed the initial cohort. We retrospectively reviewed a large cohort of forearm non-unions in adults treated during a period of 33 years (1975–2008) in a single trauma centre. closed), patient characteristics (age, co-morbidities) as well as surgeon-dependent causes (surgical technique and strategy). high energy impact, comminution, location, soft tissue damage, open vs. Most often the non-union has a multifactorial cause combining fracture characteristics (e.g. Failure to reconstitute the exact relation between radius and ulna will affect the proximal and distal joints, limiting the ability to place the hand in space. A diaphyseal forearm non-union is disabling as it effects not only the forearm but also the elbow and wrist. Typical rates reported for forearm non-unions in large cohort studies range between 2 and 10%. Complications of open reduction and internal fixation of forearm function are infection, malunion, non-union, nerve injury, compartment syndrome, bleeding, formation of a synostosis, and limited function. Benefits of plate-and-screw fixation are the ability for anatomic and secure reconstruction allowing early motion. Controversies focused on bone grafting for acute fractures, the type and length of the plate, and the risk of refracture after plate removal. Large series have shown this technique to be straightforward with a low complication rate. Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.Ĭompression plate-and-screw fixation of diaphyseal fractures of the radius and ulna in adults has been common practice since the late 1950s. 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). Complications were seen in six patients (13%). 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. All non-unions healed within a median of 7 months. ResultsĪverage follow-up time was 75 months (range 12–315 months). The functional result was assessed in accordance to the system used by Anderson and colleagues. 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 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. The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. 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. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist.
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