Alternative Management Approach for Infected Gap Non-Union of Both Bone Forearm - A Case Report

Infected gap non-union is a serious complication seen in cases of diaphyseal fracture of forearm bones. It carries high morbidity in the form of severe functional impairment and poses a challenge to treat due to the complex anatomical relationship and articulations involved. Though there are multiple treatment options available, there are no guidelines for its management. Each case is unique and requires a customized, patient-specific approach.

A 43-year-old man sustained a road traffic accident with closed both bone forearm fracture 6 months ago and was treated elsewhere with open reduction plate fixation of the radius, and Kirchner wire fixation of the ulna at an outside centre. Subsequently, he developed a purulent discharging sinus from the surgical site. After 7 months, following a trivial injury, the patient developed a deformity in his forearm. X-ray findings revealed a bent radial plate, signs of osteolysis, implant loosening along with displaced shaft of ulna fracture. The patient underwent implant removal with radial shortening and plate osteosynthesis for the radius and ulna.

In cases of infected gap non-union of radius and ulna, the key for management is thorough debridement with retention of vascularity by minimal soft tissue damage, followed by rigid fixation of the fracture. Simultaneously, adequate steps should be taken to manage the infection, such as culture-specific antibiotics and monitoring of inflammatory markers such as complete blood count, Erythrocyte sedimentation rate, and C-reactive protein.