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Treatment of diaphyseal non-unions of the ulna and radius.

Kloen P, Wiggers JK, Buijze GA - Arch Orthop Trauma Surg (2010)

Bottom Line: According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result.Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series).Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. p.kloen@amc.uva.nl

ABSTRACT

Introduction: Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation.

Method: We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed.

Patients: The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues.

Results: Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%).

Conclusion: Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

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Lateral radiograph showing a successfully treated hypertrophic ulnar non-union in a 38-year-old male. Fixation was obtained by means of a long compression plate-and-(lag)screw. Although this radiograph clearly shows an ulna minus that might have been exacerbated by using compression (shortening the ulna even more), the patient’s wrist and forearm function is normal and he is pain-free at 22 months follow-up
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Fig2: Lateral radiograph showing a successfully treated hypertrophic ulnar non-union in a 38-year-old male. Fixation was obtained by means of a long compression plate-and-(lag)screw. Although this radiograph clearly shows an ulna minus that might have been exacerbated by using compression (shortening the ulna even more), the patient’s wrist and forearm function is normal and he is pain-free at 22 months follow-up

Mentions: The average follow-up time was 75 months (range 12–315 months). All non-unions healed within 18 months after the index procedure (Figs. 1, 2) with a median time to union of 7 months (range 10–84 weeks). Range of motion at the most recent follow-up averaged 64° (range 10°–90°) for wrist flexion, 68° (range 15°–90°) for wrist extension, 64° (range 0°–80°) for pronation, 60° (range 0°–80°) for supination, 139° (range 120°–140°) for elbow flexion, and 2° (range 0°–50°) for elbow flexion contracture. Details on fracture type, treatment and function are summarised in Table 1.Fig. 1


Treatment of diaphyseal non-unions of the ulna and radius.

Kloen P, Wiggers JK, Buijze GA - Arch Orthop Trauma Surg (2010)

Lateral radiograph showing a successfully treated hypertrophic ulnar non-union in a 38-year-old male. Fixation was obtained by means of a long compression plate-and-(lag)screw. Although this radiograph clearly shows an ulna minus that might have been exacerbated by using compression (shortening the ulna even more), the patient’s wrist and forearm function is normal and he is pain-free at 22 months follow-up
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2991229&req=5

Fig2: Lateral radiograph showing a successfully treated hypertrophic ulnar non-union in a 38-year-old male. Fixation was obtained by means of a long compression plate-and-(lag)screw. Although this radiograph clearly shows an ulna minus that might have been exacerbated by using compression (shortening the ulna even more), the patient’s wrist and forearm function is normal and he is pain-free at 22 months follow-up
Mentions: The average follow-up time was 75 months (range 12–315 months). All non-unions healed within 18 months after the index procedure (Figs. 1, 2) with a median time to union of 7 months (range 10–84 weeks). Range of motion at the most recent follow-up averaged 64° (range 10°–90°) for wrist flexion, 68° (range 15°–90°) for wrist extension, 64° (range 0°–80°) for pronation, 60° (range 0°–80°) for supination, 139° (range 120°–140°) for elbow flexion, and 2° (range 0°–50°) for elbow flexion contracture. Details on fracture type, treatment and function are summarised in Table 1.Fig. 1

Bottom Line: According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result.Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series).Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. p.kloen@amc.uva.nl

ABSTRACT

Introduction: Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation.

Method: We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed.

Patients: The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues.

Results: Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%).

Conclusion: Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

Show MeSH
Related in: MedlinePlus