title: Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft?
abstract: OBJECTIVE
  Adequate treatment of forearm nonunion should achieve both biological stimulation of the bone and mechanical stability. The use of bone graft could enhance the healing of a nonunion providing osteogenic, osteoconductive and osteoinductive stimulation and an optimal stability of the fixation. We retrospectively reviewed two cohorts of patients affected by forearm nonunion and treated with plate and opposite bone graft to determine whether the use of autograft versus allograft differs in terms of (1) rate of healing of the nonunion and (2) time of healing.
  
  
  METHODS
  Thirty-four patients were treated for aseptic forearm nonunion with cortical graft strut with opposite plate and intercalary graft in case of segmental bone defect. In 20 patients an autograft harvest from the fibula (group A) and in 14 (group B) an allograft provided by the bone bank of our institution were used.
  
  
  RESULTS
  All the nonunions healed in a mean of four months in both groups, ranging from two to 12 months in group A and from three to ten months in group B. At the latest follow up forearm function and pain were satisfactory in both groups.
  
  
  CONCLUSIONS
  The use of plate and opposite bone graft demonstrated to be effective in promoting the healing of forearm nonunions, without significant differences in terms of rate and time of healing in the two groups. Considering the higher surgical time and the comorbidity of the donor site, if a bone bank is available, we suggest to use homologous cortical bone strut graft with opposite plate and screw fixation for the treatment of aseptic forearm nonunion rather than autograft.
authors.affiliation: Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.forename: Francesco
authors.initials: F
authors.lastname: Traina
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Perna
authors.forename: Raffaele
authors.initials: R
authors.lastname: Borghi
authors.forename: Matteo
authors.initials: M
authors.lastname: Nanni
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Chehrassan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D064592:Autografts; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005360:Fibula / Q000601:surgery; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult