Management of Forearm Nonunion
-
Reza Shahryar Kamrani
,
Mahmoud Farzan
,
Mohamad Sadeghian
,
Arash Farhoud
,
Mahsa Akhtarzadeh
,
Mitra Ashrafi
,
Amir Reza Farhoud
Abstract
Forearm nonunion is rare but a possible complication after standard treatment of the fracture of radius and ulna. The importance of precise restoration of length and anatomical relationship of both bones are among usual concerns. The situation is more complex when the infection is present in the union site. The several techniques have been applied to manage forearm nonunion consisting of osteosynthesis and using cancellous autograft, allograft, nonvascularized fibular graft, fibular flap, bone transport, induced membrane (Masquelet technique), and pedicled flap such as posterior interosseous and radial forearm bone flap (RFBF). Reviewing the recent studies focusing on treating forearm nonunion is the purpose of this review.
1. Soubeyrand M, Wassermann V, Hirsch C, Oberlin C, Gagey O, Dumontier C. The middle radioulnar joint and triarticular forearm complex. J Hand Surg Eur Vol. 2011;36(6):447-54. doi: 10.1177/1753193410396976. [PubMed 21447533].
2. Hahn DM. Current principles of treatment in the clinical practice of articular fractures. Clin Orthop Relat Res. 2004;(423):27-32. doi: 10.1097/01.blo.0000131234.91264.9e. [PubMed 15232422].
3. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7): 437-46. doi: 10.5435/JAAOS-22-07-437. [PubMed 24966250].
4. Reilly TJ. Isolated and combined fractures of the diaphysis of the radius and ulna. Hand Clin. 2002;18(1):179-94. doi: 10.1016/s0749-0712(02)00014-8. [PubMed 12143414].
5. Means K, Graham T. Disorders of the forearm axis. In: Wolfe MD, Scott W, editors. Green's operative hand surgery. 6th ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2010. p. 837-68.
6. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71(2):159-69. [PubMed 2918001].
7. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate
fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-97. [PubMed 1091653].
8. Prasarn ML, Ouellette EA, Miller DR. Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg. 2010;130(7):867-73. doi: 10.1007/s00402-009-1016-4. [PubMed 20012074].
9. Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB. Ununited diaphyseal forearm fractures with segmental defects: Plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am. 2004;86(11):2440-5. [PubMed 15523016].
10. dos Reis FB, Faloppa F, Fernandes HJ, Albertoni WM, Stahel PF. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann Surg Innov Res. 2009;3:5. doi: 10.1186/1750-1164-3-5. [PubMed 19450257]. [PubMed Central: PMC2694823].
11. Choi SW, Bae JY, Shin YH, Song JH, Kim JK. Treatment of forearm diaphyseal non-union: Autologous iliac corticocancellous bone graft and locking plate fixation. Orthop Traumatol Surg Res. 2021;107(8):102833. doi: 10.1016/j.otsr.2021.102833. [PubMed 33524631].
12. De Vitis R, Passiatore M, Cilli V, Maffeis J, Milano G, Taccardo G. Intramedullary nailing for treatment of forearm non-union: Is it useful? - A case series. J Orthop. 2020;20:97-104. doi: 10.1016/j.jor.2020.01.011.
13. Rollo G, Luceri F, Bisaccia M, Lanzetti RM, Luceri A, Agnoletto M, et al. Allograft versus autograft in forearm aseptic non- union treatment. J Biol Regul Homeost Agents. 2020;34 (4 Suppl. 3):207-12. [PubMed 33261279].
14. Perna F, Pilla F, Nanni M, Berti L, Lullini G, Traina F, et al. Two- stage surgical treatment for septic non-union of the forearm. World J Orthop. 2017;8(6):471-7. doi: 10.5312/wjo.v8.i6.471. [PubMed 28660139]. [PubMed Central: PMC5478490].
15. Dhar SA, Dar TA, Mir NA. Management of infected nonunion of the forearm by the Masquelet technique. Strategies Trauma Limb Reconstr. 2019;14(1):1-5. doi: 10.5005/jp-journals-10080- 1411. [PubMed 32559259]. [PubMed Central: PMC7001591].
16. Ma XY, Liu B, Yu HL, Zhang X, Xiang LB, Zhou DP. Induced membrane technique for the treatment of infected forearm nonunion: A retrospective study. J Hand Surg Am. 2022;47(6):583. doi: 10.1016/j.jhsa.2021.06.019. [PubMed
34563414].
17. Faldini C, Pagkrati S, Nanni M, Menachem S, Giannini S. Aseptic forearm nonunions treated by plate and opposite fibular autograft strut. Clin Orthop Relat Res. 2009;467(8): 2125-34. doi: 10.1007/s11999-009-0827-5. [PubMed 19350333]. [PubMed Central: PMC2706359].
18. Safoury Y. Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br. 2005;30(1):67-72. doi: 10.1016/j.jhsb.2004.09.007. [PubMed 15620495].
19. Liu T, Liu Z, Ling L, Zhang X. Infected forearm nonunion treated by bone transport after debridement. BMC Musculoskelet Disord. 2013;14:273. doi: 10.1186/1471-2474-14-273. [PubMed 24053582]. [PubMed Central: PMC3849257].
20. Ebied AM, Elseedy AI. Treatment of infected nonunion of forearm bones by ring external fixator. The Egyptian Orthopaedic Journal. 2018;53(4):341.
21. Kamrani RS, Mehrpour SR, Sorbi R, Aghamirsalim M, Farhadi L. Treatment of nonunion of the forearm bones with posterior interosseous bone flap. J Orthop Sci. 2013;18(4):563-8. doi: 10.1007/s00776-013-0395-0. [PubMed 23604642].
22. Oryadi Zanjani L, Kamrani RS, Fallah Y, Nabian MH. Vascularized osteocutaneous posterior interosseous bone flap for the treatment of nonunion of forearm bones. J Orthop Spine Trauma. 2015;1(1):e1797.
23. Shahryar KR, Farhoud AR, Nabian MH, Farhadi L. Treatment of nonunion of forearm bones using radial forearm bone flap. Trauma Mon. 2015;20(4):e22622. doi: 10.5812/traumamon.22622. [PubMed 26839858]. [PubMed Central: PMC4727466].
24. Kamrani RS, Farhoud A, Nabian MH, Zanjani LO, Farzan M. Vascularized posterior interosseous pedicled bone grafting for infected forearm nonunion. J Hand Surg Eur Vol. 2016;41(4): 441-7. doi: 10.1177/1753193415601041. [PubMed 26307139].
25. Barrera-Ochoa S, Sapage R, Alabau-Rodriguez S, Mendez-Sanchez G, Mir-Bullo X, Soldado F. Vascularized ulnar periosteal pedicled flap for upper extremity reconstruction in adults: A prospective case series of 11 patients. J Hand Surg Am. 2022;47(1):86. doi: 10.1016/j.jhsa.2021.02.027. [PubMed 34016492].
2. Hahn DM. Current principles of treatment in the clinical practice of articular fractures. Clin Orthop Relat Res. 2004;(423):27-32. doi: 10.1097/01.blo.0000131234.91264.9e. [PubMed 15232422].
3. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7): 437-46. doi: 10.5435/JAAOS-22-07-437. [PubMed 24966250].
4. Reilly TJ. Isolated and combined fractures of the diaphysis of the radius and ulna. Hand Clin. 2002;18(1):179-94. doi: 10.1016/s0749-0712(02)00014-8. [PubMed 12143414].
5. Means K, Graham T. Disorders of the forearm axis. In: Wolfe MD, Scott W, editors. Green's operative hand surgery. 6th ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2010. p. 837-68.
6. Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71(2):159-69. [PubMed 2918001].
7. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate
fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-97. [PubMed 1091653].
8. Prasarn ML, Ouellette EA, Miller DR. Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg. 2010;130(7):867-73. doi: 10.1007/s00402-009-1016-4. [PubMed 20012074].
9. Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB. Ununited diaphyseal forearm fractures with segmental defects: Plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am. 2004;86(11):2440-5. [PubMed 15523016].
10. dos Reis FB, Faloppa F, Fernandes HJ, Albertoni WM, Stahel PF. Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating. Ann Surg Innov Res. 2009;3:5. doi: 10.1186/1750-1164-3-5. [PubMed 19450257]. [PubMed Central: PMC2694823].
11. Choi SW, Bae JY, Shin YH, Song JH, Kim JK. Treatment of forearm diaphyseal non-union: Autologous iliac corticocancellous bone graft and locking plate fixation. Orthop Traumatol Surg Res. 2021;107(8):102833. doi: 10.1016/j.otsr.2021.102833. [PubMed 33524631].
12. De Vitis R, Passiatore M, Cilli V, Maffeis J, Milano G, Taccardo G. Intramedullary nailing for treatment of forearm non-union: Is it useful? - A case series. J Orthop. 2020;20:97-104. doi: 10.1016/j.jor.2020.01.011.
13. Rollo G, Luceri F, Bisaccia M, Lanzetti RM, Luceri A, Agnoletto M, et al. Allograft versus autograft in forearm aseptic non- union treatment. J Biol Regul Homeost Agents. 2020;34 (4 Suppl. 3):207-12. [PubMed 33261279].
14. Perna F, Pilla F, Nanni M, Berti L, Lullini G, Traina F, et al. Two- stage surgical treatment for septic non-union of the forearm. World J Orthop. 2017;8(6):471-7. doi: 10.5312/wjo.v8.i6.471. [PubMed 28660139]. [PubMed Central: PMC5478490].
15. Dhar SA, Dar TA, Mir NA. Management of infected nonunion of the forearm by the Masquelet technique. Strategies Trauma Limb Reconstr. 2019;14(1):1-5. doi: 10.5005/jp-journals-10080- 1411. [PubMed 32559259]. [PubMed Central: PMC7001591].
16. Ma XY, Liu B, Yu HL, Zhang X, Xiang LB, Zhou DP. Induced membrane technique for the treatment of infected forearm nonunion: A retrospective study. J Hand Surg Am. 2022;47(6):583. doi: 10.1016/j.jhsa.2021.06.019. [PubMed
34563414].
17. Faldini C, Pagkrati S, Nanni M, Menachem S, Giannini S. Aseptic forearm nonunions treated by plate and opposite fibular autograft strut. Clin Orthop Relat Res. 2009;467(8): 2125-34. doi: 10.1007/s11999-009-0827-5. [PubMed 19350333]. [PubMed Central: PMC2706359].
18. Safoury Y. Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br. 2005;30(1):67-72. doi: 10.1016/j.jhsb.2004.09.007. [PubMed 15620495].
19. Liu T, Liu Z, Ling L, Zhang X. Infected forearm nonunion treated by bone transport after debridement. BMC Musculoskelet Disord. 2013;14:273. doi: 10.1186/1471-2474-14-273. [PubMed 24053582]. [PubMed Central: PMC3849257].
20. Ebied AM, Elseedy AI. Treatment of infected nonunion of forearm bones by ring external fixator. The Egyptian Orthopaedic Journal. 2018;53(4):341.
21. Kamrani RS, Mehrpour SR, Sorbi R, Aghamirsalim M, Farhadi L. Treatment of nonunion of the forearm bones with posterior interosseous bone flap. J Orthop Sci. 2013;18(4):563-8. doi: 10.1007/s00776-013-0395-0. [PubMed 23604642].
22. Oryadi Zanjani L, Kamrani RS, Fallah Y, Nabian MH. Vascularized osteocutaneous posterior interosseous bone flap for the treatment of nonunion of forearm bones. J Orthop Spine Trauma. 2015;1(1):e1797.
23. Shahryar KR, Farhoud AR, Nabian MH, Farhadi L. Treatment of nonunion of forearm bones using radial forearm bone flap. Trauma Mon. 2015;20(4):e22622. doi: 10.5812/traumamon.22622. [PubMed 26839858]. [PubMed Central: PMC4727466].
24. Kamrani RS, Farhoud A, Nabian MH, Zanjani LO, Farzan M. Vascularized posterior interosseous pedicled bone grafting for infected forearm nonunion. J Hand Surg Eur Vol. 2016;41(4): 441-7. doi: 10.1177/1753193415601041. [PubMed 26307139].
25. Barrera-Ochoa S, Sapage R, Alabau-Rodriguez S, Mendez-Sanchez G, Mir-Bullo X, Soldado F. Vascularized ulnar periosteal pedicled flap for upper extremity reconstruction in adults: A prospective case series of 11 patients. J Hand Surg Am. 2022;47(1):86. doi: 10.1016/j.jhsa.2021.02.027. [PubMed 34016492].
| Files | ||
| Issue | Vol 8, No 4 (2022) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/jost.v8i4.10448 | |
| Keywords | ||
| Forearm Bone Fractures Fracture Healing Treatment | ||
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How to Cite
1.
Kamrani RS, Farzan M, Sadeghian M, Farhoud A, Akhtarzadeh M, Ashrafi M, Farhoud AR. Management of Forearm Nonunion. J Orthop Spine Trauma. 2022;8(4):109-112.
