Outcome of diaphyseal forearm fracture-nonunions treated by autologous bone grafting and compression plating

Prospective follow-up study in 31 consecutive patients presenting with non-unions of the forearm diaphysis (radius, n = 11; ulna, n = 9; both bones, n = 11). Surgical revision was performed by restoring anatomic forearm length by autologous bone grafting of the resected non-union from the iliac crest and compression plating using a 3.5 mm dynamic compression plate (DCP) or limited-contact DCP (LC-DCP). The main outcome parameters consisted of radiographic bony union and functional outcome, as determined by the criteria defined by Harald Tscherne in 1978. Patients were routinely followed on a short term between 6 weeks to 6 months, with an average long-term follow-up of 3.6 years (range 2 to 6 years).Radiographically, a bony union was achieved in 30/31 patients within a mean time of 3.5 months of revision surgery (range 2 to 5 months). Clinically, 29/31 patients showed a good functional outcome, according to the Tscherne criteria, and 26/31 patients were able to resume their previous work. Two postoperative infections occurred, and one patient developed a persistent infected nonunion. No case of postoperative failure of fixation was seen in the entire cohort.Revision osteosynthesis of forearm nonunions by autologous iliac crest bone grafting and compression plating represents a safe and efficacious modality for the treatment of these challenging conditions.The surgical treatment of diaphyseal forearm fracture-nonunions remains a therapeutic challenge for orthopaedic trauma surgeons. Key to success in the management of these demanding conditions is to develop a comprehensive treatment concept which considers the forearm and its adjacent joints, the elbow and wrist, as a complex functional unit [1,2]. Nonunions of the radius and ulna shaft cause a severe anatomic and functional impairment, related to disturbance of the interosseous membrane and dysfunction of the adjacent joints, elbow and wrist [3-6]. These demanding nonunions require the surgical correction to restor