Skip to main content
Top
Published in: Strategies in Trauma and Limb Reconstruction 1/2012

Open Access 01-04-2012 | Review

Management of forearm nonunions: current concepts

Authors: Peter Kloen, Geert A. Buijze, David Ring

Published in: Strategies in Trauma and Limb Reconstruction | Issue 1/2012

Login to get access

Abstract

Forearm nonunions are uncommon but severely disabling and challenging to treat. Multiple factors have been associated with the establishment of forearm nonunions such as fracture location and complexity, patient characteristics and surgical technique. Treatment of diaphyseal forearm nonunions differs from that of other type of diaphyseal nonunions because of the intimate relationship between the radius and ulna and their reciprocal movement. There is a wide variation of surgical techniques, and the optimal choice of management remains subject to debate. In this review, we aim to summarize the available evidence in the literature on forearm nonunions and combine it with practical recommendations based on our clinical experience to help guide the management of this complex problem.
Literature
1.
go back to reference Anderson LD, Sisk D, Tooms RE, Park WI 3rd (1975) Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 57(3):287–297PubMed Anderson LD, Sisk D, Tooms RE, Park WI 3rd (1975) Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am 57(3):287–297PubMed
2.
go back to reference Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB (2004) Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am 86-A(11):2440–2445PubMed Ring D, Allende C, Jafarnia K, Allende BT, Jupiter JB (2004) Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am 86-A(11):2440–2445PubMed
3.
go back to reference Ring D, Tavakolian J, Kloen P, Helfet D, Jupiter JB (2004) Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating. J Hand Surg Am 29(4):694–702PubMedCrossRef Ring D, Tavakolian J, Kloen P, Helfet D, Jupiter JB (2004) Loss of alignment after surgical treatment of posterior Monteggia fractures: salvage with dorsal contoured plating. J Hand Surg Am 29(4):694–702PubMedCrossRef
4.
go back to reference Ring D, Jupiter JB, Gulotta L (2003) Atrophic nonunions of the proximal ulna. Clin Orthop (409):268–274 Ring D, Jupiter JB, Gulotta L (2003) Atrophic nonunions of the proximal ulna. Clin Orthop (409):268–274
5.
go back to reference Kloen P, Buijze GA (2009) Treatment of proximal ulna and olecranon fractures by dorsal plating. Oper Orthop Traumatol 21(6):571–585PubMedCrossRef Kloen P, Buijze GA (2009) Treatment of proximal ulna and olecranon fractures by dorsal plating. Oper Orthop Traumatol 21(6):571–585PubMedCrossRef
6.
go back to reference Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P (2010) Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 130(4):459–464PubMedPubMedCentralCrossRef Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P (2010) Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 130(4):459–464PubMedPubMedCentralCrossRef
7.
go back to reference Buijze G, Kloen P (2009) Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 91(10):2416–2420PubMedCrossRef Buijze G, Kloen P (2009) Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 91(10):2416–2420PubMedCrossRef
8.
go back to reference Kamineni S, Hirahara H, Pomianowski S, Neale PG, O’Driscoll SW, ElAttrache N, An KN, Morrey BF (2003) Partial posteromedial olecranon resection: a kinematic study. J Bone Joint Surg Am 85(6):1005–1011PubMed Kamineni S, Hirahara H, Pomianowski S, Neale PG, O’Driscoll SW, ElAttrache N, An KN, Morrey BF (2003) Partial posteromedial olecranon resection: a kinematic study. J Bone Joint Surg Am 85(6):1005–1011PubMed
9.
go back to reference Ring D, Psychoyios VN, Chin KR, Jupiter JB (2002) Nonunion of nonoperatively treated fractures of the radial head. Clin Orthop Relat Res 398(398):235–238PubMedCrossRef Ring D, Psychoyios VN, Chin KR, Jupiter JB (2002) Nonunion of nonoperatively treated fractures of the radial head. Clin Orthop Relat Res 398(398):235–238PubMedCrossRef
10.
go back to reference Faraj AA, Livesly P, Branfoot T (1999) Nonunion of fracture of the neck of the radius: a report of three cases. J Orthop Trauma 13(7):513–515PubMedCrossRef Faraj AA, Livesly P, Branfoot T (1999) Nonunion of fracture of the neck of the radius: a report of three cases. J Orthop Trauma 13(7):513–515PubMedCrossRef
11.
go back to reference Neumann M, Nyffeler R, Beck M (2011) Comminuted fractures of the radial head and neck: is fixation to the shaft necessary? J Bone Joint Surg Br 93(2):223–228PubMedCrossRef Neumann M, Nyffeler R, Beck M (2011) Comminuted fractures of the radial head and neck: is fixation to the shaft necessary? J Bone Joint Surg Br 93(2):223–228PubMedCrossRef
12.
go back to reference Chapman MW, Gordon JE, Zissimos AG (1989) Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am 71(2):159–169PubMed Chapman MW, Gordon JE, Zissimos AG (1989) Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am 71(2):159–169PubMed
13.
14.
go back to reference Rosson JW, Shearer JR (1991) Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br 73(3):415–417PubMed Rosson JW, Shearer JR (1991) Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br 73(3):415–417PubMed
15.
go back to reference Faldini C, Pagkrati S, Nanni M, Menachem S, Giannini S (2009) Aseptic forearm nonunions treated by plate and opposite fibular autograft strut. Clin Orthop Relat Res 467(8):2125–2134PubMedPubMedCentralCrossRef Faldini C, Pagkrati S, Nanni M, Menachem S, Giannini S (2009) Aseptic forearm nonunions treated by plate and opposite fibular autograft strut. Clin Orthop Relat Res 467(8):2125–2134PubMedPubMedCentralCrossRef
16.
go back to reference Snow M, Thompson G, Turner PG (2008) A mechanical comparison of the locking compression plate (LCP) and the low contact-dynamic compression plate (DCP) in an osteoporotic bone model. J Orthop Trauma 22(2):121–125PubMedCrossRef Snow M, Thompson G, Turner PG (2008) A mechanical comparison of the locking compression plate (LCP) and the low contact-dynamic compression plate (DCP) in an osteoporotic bone model. J Orthop Trauma 22(2):121–125PubMedCrossRef
17.
go back to reference Moroni A, Rollo G, Guzzardella M, Zinghi G (1997) Surgical treatment of isolated forearm non-union with segmental bone loss. Injury 28(8):497–504PubMedCrossRef Moroni A, Rollo G, Guzzardella M, Zinghi G (1997) Surgical treatment of isolated forearm non-union with segmental bone loss. Injury 28(8):497–504PubMedCrossRef
18.
go back to reference Barbieri CH, Mazzer N, Aranda CA, Pinto MM (1997) Use of a bone block graft from the iliac crest with rigid fixation to correct diaphyseal defects of the radius and ulna. J Hand Surg Br 22(3):395–401PubMedCrossRef Barbieri CH, Mazzer N, Aranda CA, Pinto MM (1997) Use of a bone block graft from the iliac crest with rigid fixation to correct diaphyseal defects of the radius and ulna. J Hand Surg Br 22(3):395–401PubMedCrossRef
19.
go back to reference Safoury Y (2005) Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br 30(1):67–72PubMedCrossRef Safoury Y (2005) Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br 30(1):67–72PubMedCrossRef
20.
go back to reference Jupiter JB, Gerhard HJ, Guerrero J, Nunley JA, Levin LS (1997) Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft. J Bone Joint Surg Am 79(4):542–550PubMed Jupiter JB, Gerhard HJ, Guerrero J, Nunley JA, Levin LS (1997) Treatment of segmental defects of the radius with use of the vascularized osteoseptocutaneous fibular autogenous graft. J Bone Joint Surg Am 79(4):542–550PubMed
21.
go back to reference Prommersberger KJ, Fernandez DL (2004) Nonunion of distal radius fractures. Clin Orthop Relat Res 419(419):51–56PubMedCrossRef Prommersberger KJ, Fernandez DL (2004) Nonunion of distal radius fractures. Clin Orthop Relat Res 419(419):51–56PubMedCrossRef
22.
go back to reference Fernandez DL, Ring D, Jupiter JB (2001) Surgical management of delayed union and nonunion of distal radius fractures. J Hand Surg Am 26(2):201–209PubMedCrossRef Fernandez DL, Ring D, Jupiter JB (2001) Surgical management of delayed union and nonunion of distal radius fractures. J Hand Surg Am 26(2):201–209PubMedCrossRef
24.
go back to reference Prasarn ML, Ouellette EA, Miller DR (2009) Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg 130(7):867–873PubMedCrossRef Prasarn ML, Ouellette EA, Miller DR (2009) Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg 130(7):867–873PubMedCrossRef
25.
go back to reference Faldini C, Miscione MT, Acri F, Chehrassan M, Bonomo M, Giannini S (2011) Use of homologous bone graft in the treatment of aseptic forearm nonunion. Musculoskelet Surg 95(1):31–35PubMedCrossRef Faldini C, Miscione MT, Acri F, Chehrassan M, Bonomo M, Giannini S (2011) Use of homologous bone graft in the treatment of aseptic forearm nonunion. Musculoskelet Surg 95(1):31–35PubMedCrossRef
26.
go back to reference Marti RK, Kloen P (2011) Concepts and cases in nonunion treatment. Thieme Publishers Stuttgart, New YorkCrossRef Marti RK, Kloen P (2011) Concepts and cases in nonunion treatment. Thieme Publishers Stuttgart, New YorkCrossRef
Metadata
Title
Management of forearm nonunions: current concepts
Authors
Peter Kloen
Geert A. Buijze
David Ring
Publication date
01-04-2012
Publisher
Springer Milan
Published in
Strategies in Trauma and Limb Reconstruction / Issue 1/2012
Print ISSN: 1828-8936
Electronic ISSN: 1828-8928
DOI
https://doi.org/10.1007/s11751-011-0125-0

Other articles of this Issue 1/2012

Strategies in Trauma and Limb Reconstruction 1/2012 Go to the issue