Treatment of forearm diaphyseal non-union: Autologous iliac corticocancellous bone graft and locking plate fixation - 20/02/21

Doi : 10.1016/j.otsr.2021.102833

Shin Woo Choi ^a, Joo Yul Bae ^a, Young Ho Shin ^b, June Hoe Song ^c, Jae Kwang Kim ^b,⁎
^a Department of orthopedic surgery, Gangneung Asan hospital, University of Ulsan college of medicine, Gangneung, Korea
^b Department of orthopedic surgery, Asan Medical center, University of Ulsan college of medicine, Seoul, Korea
^c Department of orthopedic surgery, Ewha Womans University Mokdong hospital, Seoul, Korea

^⁎Corresponding author.

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Abstract

Introduction

Studies conducted on forearm bone diaphysis non-union are limited due to the rarity of this condition. The present study aimed to evaluate the outcome of our technique using autologous iliac corticocancellous bone graft fixed by locking plate system for the forearm bone diaphyseal non-union without infection.

Patients and methods

We treated eight patients with non-union of radial or ulnar shaft fracture (four men, four women) aged 38 years (range: 18–52 years) on average. The average follow-up period was 18 months (range: 12–24 months). In our technique, we applied the locking plate to the diaphyseal bone fragment, before grafting the bone block to the non-union site. After excision of sclerotic ununited bone, the autologous iliac corticocancellous bone was grafted to the defect and fixed with single locking screw. Pain, grip strength, and disabilities of the arm, shoulder, and hand (DASH) score were measured and compared before and 12 months after the surgery. Radiographs were taken at each follow-up, and the time of bony union was determined.

Results

The mean time to radiological union was 4.2 months (range: 3–6 months), and bony union was achieved in all cases within 6 months. All measured values, visual analog scale, DASH score, and grip strength, were significantly improved at 12 months after surgery (p<0.05). No minor/major complications including infection, non-union, or malunion were reported.

Conclusions

Locking compression plate fixation and autologous iliac corticocancellous bone grafting with a holding locking screw appears to be a reliable primary procedure for non-union of the forearm diaphyseal fracture without infection.