Nonunion of Adult Forearm Fractures: Evaluation of Intramedullary Nailing With Grafting as a Treatment Option

Abstract

OBJECTIVES: To evaluate the effectiveness of intramedullary nailing combining with iliac or fibular autograft for the treatment of adult forearm nonunions. Design:Retrospective case series. Setting:Two academic trauma referral centers. Patient Selection Criteria:Adult patients who sustained surgical treatment for forearm fracture (OTA/AO 2R2-2U2) nonunion with intramedullary nailing and grafting from May 2005 to January 2023 were included. Outcome Measures and Comparisons:The primary outcome was to determine the bone union rates after nonunion surgery with intramedullary nail and grafting. Secondary outcomes were to assess functional scores including The Visual Analog Score; the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; Grace-Eversmann evaluation criteria. RESULTS: The study included 24 patients comprising 19 men and 5 women (7 radius, 14 ulna, 3 both bones) with an average age at the time of surgery of 40.5 +/- 11.2 years (range, 23-61 years) and union was achieved for 24 out of 27 bones (88.8%) in 22 out of 24 patients. The mean (average) preoperative and postoperative QuickDASH scores were found as 64.5 +/- 18.2 and 15.3 +/- 18.9, respectively. The functional improvement was found statistically significant (P < 0.001). The mean (average) preoperative and postoperative Visual Analog Score was found to be 7.2 +/- 2.1 and 1.52 +/- 1.5, respectively. The difference was found statistically significant (P < 0.001). Two cases of radius nonunion healed with 10 degrees and 15 degrees of angulation and shortening, while nonunion persisted in 2 patients. All remaining cases healed without deformity. Excellent to acceptable results were obtained for 83.3% of patients according to Grace-Eversmann criteria. CONCLUS & Idot;ONS: Intramedullary nailing with autologous grafting is a viable option for the treatment of adult forearm nonunions. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.