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Published on: November 13, 2016
Nonunion of Adult Forearm Fractures: Evaluation of Intramedullary Nailing With Grafting as a Treatment Option
Tolga Onay1, Mesut Akkaya2, Mehmet Dilek1
1Department of Orthopedics and Traumatology, Istanbul Medeniyet University, Istanbul, Turkey.
Objectives:
To evaluate the effectiveness of intramedullary nailing combining with iliac or fibular autograft for the treatment of adult forearm nonunions.
Design:
Retrospective case series.
Setting:
Two academic trauma referral centers.
Patient Selection Criteria:
Adult patients who sustained surgical treatment for forearm fracture (OTA/AO 2R2-2U2) nonunion with intramedullary nailing and grafting from May 2005 to January 2023 were included.
Outcome Measures And Comparisons:
The primary outcome was to determine the bone union rates after nonunion surgery with intramedullary nail and grafting. Secondary outcomes were to assess functional scores including The Visual Analog Score; the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; Grace-Eversmann evaluation criteria.
Results:
The study included 24 patients comprising 19 men and 5 women (7 radius, 14 ulna, 3 both bones) with an average age at the time of surgery of 40.5 ± 11.2 years (range, 23-61 years) and union was achieved for 24 out of 27 bones (88.8%) in 22 out of 24 patients. The mean (average) preoperative and postoperative QuickDASH scores were found as 64.5 ± 18.2 and 15.3 ± 18.9, respectively. The functional improvement was found statistically significant ( P < 0.001). The mean (average) preoperative and postoperative Visual Analog Score was found to be 7.2 ± 2.1 and 1.52 ± 1.5, respectively. The difference was found statistically significant ( P < 0.001). Two cases of radius nonunion healed with 10 degrees and 15 degrees of angulation and shortening, while nonunion persisted in 2 patients. All remaining cases healed without deformity. Excellent to acceptable results were obtained for 83.3% of patients according to Grace-Eversmann criteria.
Conclusons:
Intramedullary nailing with autologous grafting is a viable option for the treatment of adult forearm nonunions.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
