Nonunions of the distal radius

Ten nonunions were treated with open reduction, internal fixation, and iliac crest bone graft (7 bicortical corticocancellous; 3 cancellous) through either a dorsal (8) (6 bicortical; 2 cancellous graft) or a palmar (2) approach (1 corticocancellous; 1 cancellous graft), depending on angulation and collapse. After the procedure, the patients wore casts for 2 weeks and then splints for 2 weeks, after which they progressed from active assisted range-of-motion exercises to active range-of-motion and strengthening exercises. Follow-up averaged 18.9 months (range, 9-45 months). Of the 10 patients, there were 8 unions which attained adequate range of motion of the wrist, as demonstrated by the following averages: flexion, 50 degrees; extension, 38 degrees; pronation, 73 degrees; supination, 58 degrees. Grip strength and key pinch averaged 71% and 86% of the opposite side, respectively. Five patients returned to preinjury activity levels or employed status. Five patients were unable to return to work because of associated injuries and pain (5) and poor wrist function (1). These results indicate that nonunion of the distal radius can be treated with open reduction, internal fixation, and bone grafting, that union can be attained, and that function can be restored.