FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF UNUNITED DIAPHYSEAL FOREARM WITH COMPRESSION PLATE FIXATION AND AUTOGENOUS BONEGRAFTING

Ward Nazih Samoua*, Ghiyas Halloum and Ali Youssef

ABSTRACT

Introduction: The treatment of forearm fracture-nonunions continues to represent a therapeutic challenge, and reported outcomes are moderate at best. Limiting aspects of this particular anatomic location include the relation between restoration of shaft length with the anatomy and long-term functional outcome of adjacent joints, as well as the risk of elbow and wrist stiffness related to prolonged immobilization. The present study was designed to assess the outcome of autologous bone grafting with compression plating and early functional rehabilitation in patients with forearm fracture non-unions. Methods: Prospective follow-up study in 23 consecutive patients presenting with non-unions of the forearm diaphysis (radius, n = 8; ulna, n = 9; both bones, n = 7). Surgical revision was performed by restoring anatomic forearm length by autologous bone grafting of the resected non-union from the iliac crest and compression plating using a 3.5 mm dynamic compression plate (DCP) or limited-contact DCP (LC-DCP). The main outcome parameters consisted of radiographic bony union and functional outcome, as determined by the criteria defined by Grace and Everssman 1980. Patients were routinely followed on a short term between 2 weeks to 9 months. Results: Radiographically, a bony union was achieved in 22/23 patients within a mean time of 5 months of revision surgery (range 3 to 7 months). Clinically, 13/23 patients showed an excellent functional outcome, 8/23 patients showed a good functional outcome, 2/23 patients showed a bad functional outcome according to the Grace and Everssman criteria. No patient had a postoperative infections. Two case of postoperative failure of fixation was seen, one of them developed to malunion and the second one stay as a nonunion case. Conclusion: Revision osteosynthesis of forearm nonunions by autologous iliac crest bone grafting and compression plating represents a safe and efficacious modality for the treatment of these challenging conditions.

Keywords: Forearm, Compression plate, nonunion, bonegrafting.