Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2017; 8(6): 471-477
Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.471
Two-stage surgical treatment for septic non-union of the forearm
Fabrizio Perna, Federico Pilla, Matteo Nanni, Lisa Berti, Giada Lullini, Francesco Traina, Cesare Faldini
Fabrizio Perna, Federico Pilla, Matteo Nanni, Lisa Berti, Giada Lullini, Francesco Traina, Cesare Faldini, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
Author contributions: Perna F gives the most important contributions to the conception of the paper end designed it; Pilla F and Nanni M were of paramount importance in drafting the work and revising it critically; Berti L and Lullini G helped in the acquisition, analysis and interpretation of data for the work; finally Traina F and Faldini C give us the final approval of the version to be published.
Institutional review board statement: This study received the ethical approval from the institutional review board statement of the Rizzoli Orthopaedic Institute of Bologna (No. 0021967).
Informed consent statement: All patients involved in this study gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Authors agreed to share data with the editor.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Fabrizio Perna, MD, Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136 Bologna, Italy.
Telephone: +39-051-6366368 Fax: +39-051-6366212
Received: January 23, 2017
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.

Keywords: Forearm fractures, Non-union, Delayed union, Infection, Open fracture, External fixation, Bone graft

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.