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J Wrist Surg 2024; 13(06): 508-515
DOI: 10.1055/s-0043-1776353
Scientific Article

A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention

Soo Min Cha
1   Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
,
In Ho Ga
1   Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
,
Yong Hwan Kim
1   Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
,
Seung Won Kim
1   Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
› Author Affiliations
Funding This work was supported by the research fund of Chungnam National University, 2022.
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Abstract

Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend.

Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4).

Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius.

Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna.

Level of Evidence Level IV, retrospective case series.

Keywords

distal radioulnar - fractures - metaphysis - bone graft - stability

Ethical Approval

This study was reviewed and approved by the Institutional Review Board of Chungnam National University Hospital (IRB No. 2022–04–001).


Informed Consent

Informed consent was obtained from all individual participants included in the study. There is NO information (names, initials, hospital identification numbers, or photographs) in the submitted manuscript that can be used to identify patients.




Publication History

Received: 02 July 2023

Accepted: 28 September 2023

Article published online:
07 November 2023

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