Evaluation Of Outcomes In Non-unions Of The Ulna And Radius Diaphyses Treated With Autologous Bone Grafting And Plating

ObjectiveTo evaluate the functional and radiological results of surgical treatment of diaphyseal nonunion of the radius and ulna,with autologous bone grafting and internal plate fixation.MethodsA total of 28 patients(22 males,6 females;mean age: 38.5 years)with nonunion after surgical treatment of forearm fractures who were treated in our department from January 2007 to June 2016 were included.Nonunion was located in the ulna in 9 patients,in the radius in 15 patients,and in both in 4 patients(13 ulna,19 radius).Surgical revision was performed by restoring anatomic forearm length by autologous bone grafting of the resected nonunion from the iliac crest and compression plating using a 3.5 mm dynamic compression plate(DCP)or limited-contact DCP(LC-DCP)or locking compression plate(LCP).The main outcome parameters consisted of radiographic bony union and functional outcome,Time to unifcation,range of motion in the wrist,elbow joints and forearm pronation/supination and complications were analyzed.The patients were followed-up to assess pain on Visual Analogue Scale(VAS),Functional evaluation was performed using the scoring system based on the joint ROMs at final follow-up.Results were recorded through the DASH questionnaire and the Anderson score.The outcomes between different fixations were compared.ResultsFollow-up was 12-102 months,with a median follow-up time of 58.5 months.Unification of 27 patients(31 nonunions)was achieved within 6 months.The ROM of wrist flexion/extension,pronation/supination and elbow flexion/extension in patients after surgery have been improved to different extents;According to the criteria of Anderson et al,there were excellent in 16 cases,good in 8,fair in 3,and 1 had a fail,the excellent and good rate was 85.7%.Postoperative DASH score was 0-39.2 points,with a median score of 5.4.2 patients refractured after hardware removal and underwent renewed plate fixation.7 patients suffer regional pain of iliac crest or forearm surgical site.In three cases a superfcial infection developed at the graft donor site or forearm surgical site.DCP and LCP fixation for ulna and radius nonunion has similar outcome.ConclusionViolent injury and iatrogenic factors are main causes of radius and ulna nonunion,and iatrogenic factors could be avoided by standardized surgical treatment.Radius and ulna fractrue are highly required in fixation since its special anatomy,and the treatment principle of radius and ulna diaphyseal nonunion are: nonunion site preparation,precise reduction,rigid fixation,adequate bone graft,early mobilization.DCP and LCP fixation for ulna and radius nonunion has similar outcome.Reasonable,standardized operation could prevent the recurrence of radius and ulna fractures after plate removal,iliac pain and other complications.