Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.471
Peer-review started: February 5, 2017
First decision: March 28, 2017
Revised: April 21, 2017
Accepted: May 12, 2017
Article in press: May 15, 2017
Published online: June 18, 2017
To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.
Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years (19-57 years) and a mean follow-up of 6 years (2-10 years). All patients presented an atrophic non-union with a mean length of the bone defect of 1.8 cm (1.2-4 cm). Complications and clinical results after surgical treatment were recorded.
Mean time to resolution of the infectious process was 8.2 wk (range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo (range 2-10 mo) after the second step surgery. Cultures on intraoperative samples were positive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5 (27.8%) patients, satisfactory in 10 (55.5%) and unsatisfactory in 3 (16.7%) patients. No activities of daily living (ADLs) limitations were reported by 12 (66.6%) patients, slight by 3 (16.6%) and severe limitation by 3 (16.6%) patients. Mean visual analog scale at the last follow-up was 1 (0-3).
The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good functional results and low rate of complications.
Core tip: Forearm non-union represent a challenging condition for the orthopaedic surgeon. Septic forms are even more difficult to overcome. However, in the present study we found that good clinical results can be achieved using a dual stage surgical technique with the first aim to resolve the infection process and subsequently achieve bone union.