Treatment of diaphyseal non-unions of the ulna and radius.
BACKGROUND
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.


METHODS
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.


METHODS
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%).


CONCLUSIONS
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.
Kloen
Peter
P
Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. p.kloen@amc.uva.nl
Wiggers
Jim K
JK
Buijze
Geert A
GA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation; D018483:Diaphyses; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000601:surgery*