title: Treatment of Infected Forearm Nonunions With Large Complete Segmental Defects Using Bulk Allograft and Intramedullary Fixation.
abstract: OBJECTIVE
  The purpose of this study is to report the results of a series of infected forearm nonunions treated from 1998 to 2012 using a staged reconstruction technique.
  
  
  METHODS
  At a median of 42 months follow-up, 7 patients who had an average segmental defect of 4.9 cm (range, 2.3-10.4 cm) were available for clinical and radiographic evaluation. Treatment consisted of serial debridement, implantation of an antibiotic cement spacer, and staged reconstruction using a bulk radius or ulna allograft with intramedullary fixation.
  
  
  RESULTS
  All 7 patients ultimately achieved solid bone union, although 4 patients (57%) required additional surgery, consisting of autologous bone grafting and plating, to achieve healing at 1 of the allograft-host junction sites. No patient had recurrence of infection, and all reported substantial improvement with increased function and decreased pain.
  
  
  CONCLUSIONS
  Our approach ultimately resulted in a 100% union rate without recurrence of infection, although many patients may require additional surgery to attain healing at both allograft-junction sites. Using bulk allograft provides the ability to span a large defect while reconstituting the forearm anatomy.
  
  
  METHODS
  Therapeutic V.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Davis
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Andrew
authors.initials: A
authors.lastname: Choo
authors.affiliation: Department of Health and Human Performance, University of Houston, Houston, TX. Electronic address: dpoconno@central.uh.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Connor
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX; Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Brinker
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000188:drug therapy / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D003646:Debridement; D005260:Female; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005597:Fractures, Open / Q000188:drug therapy / Q000601:surgery; D005599:Fractures, Ununited / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011884:Radius / Q000293:injuries / Q000601:surgery / Q000637:transplantation; D011885:Radius Fractures / Q000188:drug therapy / Q000601:surgery*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014457:Ulna / Q000293:injuries / Q000601:surgery / Q000637:transplantation; D014458:Ulna Fractures / Q000188:drug therapy / Q000601:surgery*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Nonunited fracture; radius; reconstruction; trauma; ulna