Surgical treatment of non-unions in the ulna and radius: a one-year outcome study

TL;DR

This study evaluates the effectiveness of surgical treatment for non-unions in the forearm bones, showing improved healing and patient outcomes over one year.

Contribution

The study provides new insights into the optimal follow-up duration and grafting techniques for treating forearm non-unions.

Findings

89% of patients showed bone consolidation after one year of surgical treatment.

Cortico-cancellous bone grafting combined with LCP achieved 100% consolidation at one year.

Patient-reported outcomes improved significantly following treatment.

Abstract

The incidence of non-unions of the forearm following conservative or surgical treatment of forearm fractures ranges from 2% to 5.3%. These non-unions can lead to significant limitations in the patient’s physical capabilities, necessitating an appropriate treatment plan. The aim of this study was to evaluate osseous consolidation of forearm non-unions after six months and one year as well as to assess patient-reported outcomes. A total of 36 patients with non-unions of the forearm, operatively treated in our department between 01/10 and 12/21, completed the follow-up period for this study. Radiographic evaluation was performed using the modified Lane-Sandhu Score. Osseous consolidation was assessed at six and 12 months postoperatively. Additionally, patient-reported outcomes and variations of surgical treatment were analysed. The prevalence of non-unions in our study was 30.56% for the ulna, 50% for the radius, and 19.44% for both bones. 85% of patients received bone grafts, with 48% receiving cortico-cancellous bone grafts (CCBG) and 52% receiving cancellous bone from the iliac crest or femur. In total, 67% of patients demonstrated consolidation of the non-union within six months of surgical treatment, increasing to 89% after one year. Among patients who received CCBG, 86% showed consolidation at six months, rising to 100% at one year. Additionally, patient-reported outcome measures (PROMs), including VAS and SF-12 scores, showed overall improvement. A sufficiently long follow-up period is crucial for patients with forearm non-unions. To ensure consolidation, a follow-up period of at least six months to one year is recommended. Furthermore, the use of cortico-cancellous bone grafting combined with locking compression plates (LCP) appears to be an effective technique, providing stability during the healing process and achieving satisfactory bone healing one year postoperatively.

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