OTA 1997 Posters - Forearm Fractures

Treatment of Nonunion of the Forearm Utilizing the Ilizarov Technique: A Review of Thirty-three Cases

Anthony F. Infante, Jr., DO, Maurizio A. Catagni, MD, Phillip Schmitt, DO, Bradley Jelen, DO

Tampa, Florida, USA

Hypothesis: The Ilizarov technique can be successfully used for treating nonunions of the forearm, especially those with bone loss or infection.

Materials and Methods: From 1983 to 1995, 33 cases of nonunion of the forearm were treated utilizing the Ilizarov technique. The Ilizarov technique was chosen after other treatment modalities such as casting and open reduction and internal fixation had failed. The goals were union at the pseudoarthrosis site, removal of infected, dead bone and maintenance of length, alignment and motion. The Ilizarov technique used for the forearm nonunions in the study was previously described by the senior author. Seven of the 33 cases were infected nonunions. Ten of the 33 nonunions had bone loss from two to six centimeters prior to or after debridement of the nonunion site. Five of these were in the infected nonunion group and required irrigation and debridement. These ten with significant bone loss were treated with a bifocal frame and bone transport. There were ten other cases with bone loss less than 1.5 cm which were treated with a bifocal frame and compression/distraction osteosynthesis. The remaining seven cases were treated with a monofocal frame and compression.

Results: Even with infections, deformities and bone loss complicating many of these nonunions, 32 of 33 united with the Ilizarov technique. The number of months in the Ilizarov external fixator ranged from 3 to 22 months with a median of 5 months. Follow-up of the 33 patients ranged from 5 to 30 months. Normal radial and ulnar length was restored in eight of the ten nonunions with significant bone loss. All of the forearms were free of infection. All of the 33 patients were able to regain function of the affected extremity. There was one nonunion that failed to unite at the docking site after bone transport. The nonunion was opened, debrided, bone grafted and plated. It too united in four months. Complications included the one nonunion, a delayed union that required a second frame, an ulnar positive wrist, two ulnar head subluxations and one proximal radius and ulna synostosis. The goals of treatment (union, aseptic bone and use of the arm and hand) were reached in 32 of the 33 patients.

Discussion and Conclusion: The application of Ilizarov techniques to nonunions of the forearm with or without bone loss and/or infection is proving to be a valuable tool. The Ilizarov technique has been reported on in the eastern and western worlds for use with tibial, humeral and femoral nonunions but this is the first series of forearm nonunions that we are aware of. It is especially useful in cases with considerable bone loss with or without infection. The Ilizarov circular frame incorporates the advantages of ORIF, vascularized bone grafts, and external fixators into one procedure. The Ilizarov technique allows resection of the infected bone area, compression at the nonunion site, repair of the bone defect by internal transport of bone segment and stabilization of the bone to consolidation, while maintaining or restoring length of the limb and articular motion.