# Management of post-infection forearm defect non-unions following the “Road-to-Union” protocol: technical note and case series

## TL;DR

This paper presents a case series on using the 'Road-to-Union' protocol to treat complex forearm non-unions, aiming to restore bone healing and function.

## Contribution

The study adapts the 'Road-to-Union' protocol originally for tibial defects to treat forearm non-unions, a novel application in orthopedic surgery.

## Key findings

- The 'Road-to-Union' protocol was successfully adapted for forearm non-unions, addressing infection, bone loss, and deformity.
- The two-stage approach restored structural integrity and function in complex forearm non-union cases.
- This case series demonstrates the potential of the protocol as a systematic solution for challenging forearm defects.

## Abstract

Diaphyseal non-union of forearm fractures that involve both the ulna and radius present unique challenges to treat. If left untreated, these non-unions may lead to severe instability of the forearm and/or chronic pain. Existing treatments include bone grafting, fibular grafts, and the Masquelet technique, however, currently no gold standard treatment exists. The “Road-to-Union” protocol is a two-stage surgical approach originally developed for managing complex tibial bone defects. It integrates debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and structured rehabilitation. This technique addresses challenges such as infection, bone loss, and deformity by providing a systematic pathway to achieve bone healing and restore function. While traditionally used in the lower limb, its application in the forearm has not been widely reported. This case series explores the adaptation of the “Road-to-Union” protocol for forearm reconstruction, aiming to restore structural integrity and function in complex non-union cases.