Post-traumatic nonunion of the forearm in adults

Post-traumatic forearm nonunion in adults is a rare but formidable complication. Therapeutic objectives must combine bone union with restoration of radial anatomy and pronator curvature, in order to regain pronosupination function and ideal hand positioning. The rate of nonunion in forearm diaphyseal fractures, with or without infection, is in the range of 2-10%. Failed healing of these fractures is often due to an inadequate surgical technique. The objectives of the clinical and diagnostic assessment are to characterize the trauma and its initial management, the nonunion and the patient. AP, lateral and three-quarter radiographs of the forearm, including the wrist and elbow joints, are essential. CT scans of the forearm with MPR and 3D reconstructions provide the details needed to characterize the nonunion and the surrounding bone tissue. If infection is suspected, blood tests should be performed to check for inflammatory syndrome. The extent of segmental bone loss and whether or not the nonunion is infected dictate the treatment options available. The reference internal fixation is a plate. LEVEL OF EVIDENCE: >V; expert opinion.