Forearm bone non-union and its management

A total of 125 patients with forearm (radio-ulnar) bone compound fractures resulting from missile injuries were examined 8 to 16 weeks after the time of injury with the objective of finding out the rate and causes of non-union. Initial management in each case was circular POP with windows for wound care or posterior slabs made of POP, Cramer-wire, or wood at random. Out of these, 22 (17.5%) patients had non-union. All were male, mean age 26 years, in good nutritional state and no underlying chronic illnesses found on routine examination. Fourteen had ulnar bone and 8 radial bone non-union. Four of the patients with ulnar non-union had both radio-ulnar fracture. All 22 patients had haematocrit values > 30%, had no associated injury and none had vascular injury at site of wounding. Seven (32%) had wound infection. All wounds healed within 2-4 weeks after injury. Diagnosis of non-union was made by clinical examination and x-rays of the forearm. All the 22 cases were operated on under general anaesthesia and exploration revealed that 18 had bone defects ranging from 1 cm to 5 cm, 2 had soft tissue interposition and 2 had failure of reduction as the obvious cause of non-union. Cancellous, slivered iliac bone grafts were made in all cases to bridge gaps and induce osteogenesis. Stabilization was made by rush-pins used as intramedullary nails in 12 cases in addition to either long or short arm plaster of paris casts in all cases. There was no post-operative infection including the donor site and all had well healed wounds and good union 8-10 weeks later. Bone defect is the most common cause of non-union of forearm bone fractures resulting from missile injury and early slivered cancellous bone graft is effective in the treatment of non-union.