Vascularized bone grafts in the treatment of infected forearm nonunions

Infected nonunions of both-bone forearm fractures may not respond to conventional treatment. Four patients with infected nonunions were successfully treated with vascularized fibular grafts and conversion to a one-bone forearm after failure of as many as six procedures. The fibula was fixed to the ulna proximally and the radius distally with internal fixation, and this was supplemented with an external fixator in three of the four patients. All wounds healed and all bone junctures healed primarily with the exception of one that required supplemental cancellous grafting. Free vascularized fibular grafts should be considered for infected nonunions that are unresponsive to properly executed conventional surgical and antibiotic treatment.