Treatment of Diaphyseal Forearm Nonunions with Interlocking Intramedullary Nails

Abstract

Fifteen patients with 26 nonunions of diaphyseal forearm fractures were treated with interlocking intramedullary nails and iliac bone grafts. The purpose of our study was to evaluate the rate of successful healing and complications that developed after using this technique. The mean followup was 31 months (range, 25-38 months). The average length of bone loss after freshening the bone ends was 20 mm (range, 10-30 mm). Radiographic union was achieved in 14 patients (96%). Compared with the uninjured contralateral arm, the mean loss of flexion and extension motion at the wrist was 27°. The mean loss of the arc of motion at the elbow was 18°, and the mean loss of rotation of the forearm was 39°. In seven patients, the amount and location of the maximum radial bow on the injured side were significantly different from those of the contralateral arm. Using the rating system of Anderson et al, two patients (13%) had excellent results, six patients (40%) had satisfactory results, six patients (40%) had unsatisfactory results, and one patient (7%) had a failed result. The mean Disabilities of the Arm and Shoulder Score was 35 points (range, 16-56 points), indicating moderate residual impairment. There were three postoperative complications (an incidence of 12%). Our results showed that interlocking intramedullary nailing of nonunions of the diaphysis of the radius or ulna with an open reaming technique should not be considered an adequate alternative to plate fixation of these injuries. Level of Evidence: Therapeutic study, Level IV (case series no, historical control group). See the Guidelines for Authors for a complete description of levels of evidence.