Nonunion of Adult Forearm Fractures: Evaluation of Intramedullary Nailing With Grafting as a Treatment Option
Journal of Orthopaedic Trauma, cilt.39, sa.3, ss.120-126, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 39 Sayı: 3
- Basım Tarihi: 2025
- Doi Numarası: 10.1097/bot.0000000000002944
- Dergi Adı: Journal of Orthopaedic Trauma
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.120-126
- Anahtar Kelimeler: forearm, nonunion, intramedullary nail
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
OBJECTIVES: To evaluate the effectiveness of intramedullary nailing combining with iliac or fibular autograft for the treatment of adult forearm nonunions. METHODS: 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 6 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 6 18.2 and 15.3 6 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 6 2.1 and 1.52 6 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. CONCLUSIONS: _ Intramedullary nailing with autologous grafting is a viable option for the treatment of adult forearm nonunions.