Modern concepts of treatment of complicated diaphyseal forearm fractures (literature review)

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The analysis of modern domestic and foreign literature on the issues of surgical treatment of patients with diaphyseal forearm fractures is presented in the article, the main problems at these injuries are noted. The analysis has been carried out on the basis of databases of medical publications of CyberLeninka, eLibrary, PubMed and biliary databases. The treatment of complicated diaphyseal forearm fractures in the form of nonunions, pseudoarthrosis, defects and malunion is serious problem in traumatology and orthopaedics, because according to the literature data, unsatisfactory results in the treatment of this pathology reach 20–47%. This problem requires the development and implementation of modern functional methods of treatment, which would allow to combine the period of restoration of segment integrity with the period of rehabilitation without risk of osteosynthesis instability and nonunion. The problem of choosing the optimal tactics and methods of surgical fixation of these lesions remains a subject for discussion, which is the basis for scientific research on optimization of tactics and methods of surgical treatment of patients with consequences of diaphyseal forearm fractures.

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About the authors

Sergey N. Chernyaev

Mechnikov North-Western State Medical University; Mariinsky City Hospital

Author for correspondence.

MD, Cand. Sci. (Med.), assistant lecturer, Department of Traumatology and Orthopedics, Head of the Department of Traumatology and Orthopedics

Russian Federation, Saint Petersburg

Valentin A. Neverov

Mechnikov North-Western State Medical University; Mariinsky City Hospital


MD, PhD, Dr. Sci. (Med.), Professor, Head of the Department of Traumatology and Orthopedics, Chief of the Department of Traumatology and Orthopedics

Russian Federation, Saint Petersburg


  1. Anderson LD, Sisk TD, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287–297.
  2. Faldini C, Pagkrati S, Nanni M, et al. Aseptic forearm nonunions treated by plate and opposite fiular autograft strut. Clin Orthop Relat Res. 2009;467(8):2125–2134. doi: 10.1007/s11999-009-0827-5.
  3. Faldini C, Miscione MT, Acri F, et al. Use of homologous bone graft in the treatment of aseptic forearm nonunion. Musculoskelet Surg. 2011;95(1):31–35. doi: 10.1007/s12306-011-0117-8.
  4. Wei SY, Born CT, Abene A, et al. Diaphyseal forearm fractures treated with and without bone graft. J Trauma. 1999;81(1):1045–1048. doi: 10.1097/00005373-199906000-00011.
  5. Jayakumar P, Jupiter JB. Non-union in forearm fractures. Acta Chir Orthop Traumatol Cech. 2014;81(1):22–32.
  6. Boussakri H, Elibrahimi A, Bachiri M, et al. Nonunion of fractures of the ulna and radius diaphyses: clinical and radiological results of surgical treatment. Malays Orthop J. 2016;10(2):27–34 doi: 105704/MOJ1607006.
  7. Kloen P, Wiggers JK, Buijze GA. Treatment of diaphyseal nonunions of the ulna and radius. Arch Orthop Trauma Surg. 2010;130(12):1439–1445. doi: 10.1007/s00402-010-1071-x.
  8. Osman L, Yavuz A, Umut Y, et al. Evaluation of outcomes in aseptic non-unions of the forearm bones in adults treated with LCP and autograft. Ulus Travma Acil Cerrahi Derg. 2016;22(3):283–289. doi: 10.5505/tjtes.2015.73780.
  9. Ring D. Monteggia fractures. Orthop Clin N Am. 2013;44(2):59–66. doi: 10.1016/j.ocl.2012.08.007.
  10. Richard MJ, Ruch DS, Aldridge JM 3rd. Malunions and nonunions of the forearm. Hand Clin. 2007;23(2):235–243. doi: 10.1016/j.hcl.2007.02.005.
  11. Nicoll EA. The treatment of gaps in long bones by cancellous insert grafts. J Bone Joint Surg. 1956;38-B(1):70–82. doi: 10.1302/0301-620X.38B1.
  12. Илизаров Г.А., Каплунов А.Г., Дегтярев В.Е. Лечение ложных суставов и несросшихся переломов, осложненных инфекцией, методом компрессионно-дистракционного остеосинтеза. Ортопедия, травматология и протезирование. 1972;(11):10–14. [Ilizarov GA, Kaplunov AG, Degtyarev VE. Treatment of pseudoarthrosis and non-union fractures complicated by infection using compression-distraction osteosynthesis. Ortopediya, travmatologiya i protezirovanie. 1972;(11):10–14. (In Russ.)]
  13. Соколова М.Н. Лечение больных с дефектами и ложными суставами костей предплечья методом чрескостного остеосинтеза: Автореф. дис. … канд. мед. наук. Курган, 2011. 28 с. [Sokolova MN. Lechenie bol’nykh s defektami i lozhnymi sustavami kostei predplech’ya metodom chreskostnogo osteosinteza. [dissertation abstract]. Kurgan; 2011. 28 p. (In Russ.)]
  14. Kamrani RS, Mehrpour SR, Sorbi R. Treatment of nonunion of the forearm bones with posterior interosseous bone flap. J Orthop Sci. 2013;18:563–568. doi: 101007/s00776-013-0395-0.
  15. Kinoshita M, Naito K, Aritomi K, et al. Forearm nonunion caused by hyperparathyroidism with 7 years follow up: a case report. Int J Surg Case Rep. 2017;38:158–162. doi: 101016/jijscr201707032.
  16. McKee MD, Miranda MA, Riemer BL. Management of humeral nonunion after the failure of locking intramedullary nails. J Orthop Trauma. 1996;10(7):492–499. doi: 10.1097/00005131-199610000-00008.
  17. Kuyucu E, Koçyiğit F, Ciftçi L. The importance of patient compliance in nonunion of forearm fracture. Int J Surg Case Rep. 2014;5(9):598–600. doi: 101016/jijscr201404033.
  18. Faldini C, Traina F, Perna F, et al. Surgical treatment of aseptic forearm nonunion with plate and opposite bone graft strut. Autograft or allograft? Int Orthop. 2015;39(7):1343–1349. doi: 101007/s00264-015-2718-6.
  19. Афаунов А.И., Афаунов А.А., Плясов С.А., Васильченко П.П. Хирургическая тактика устранения сегментарных дефектов костей предплечья. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2008;(1):44–52. [Afaunov AI, Afaunov AA, Plyasov SA, Vasil’chenko PP. Surgical tactics for eliminating segmental defects of the forearm bones. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2008;(1):44–52. (In Russ.)]
  20. Kloen P, Buijze GA, Ring D. Management of forearm nonunions: current concepts. Strategies Trauma Limb Reconstr. 2012;7(1):1–11. doi: 10.1007/s11751-011-0125-0.
  21. Prasarn ML, Ouellette EA, Miller DR. Infected nonunions of diaphyseal fractures of the forearm. Arch Orthop Trauma Surg. 2010;130(7):867–873. doi: 10.1007/s00402-009-1016-4.
  22. Regan DK, Crespo AM, Konda SR, Egol KA. Functional outcomes of compression plating and bone grafting for operative treatment of nonunions about the forearm. J Hand Surg Am. 2018;43(6):564e1–564e9. doi: 101016/jjhsa201710039.
  23. Zhang Q, Yin P, Hao M, et al. Bone transport for the treatment of infected forearm nonunion. Injury. 2014;45(12):1880–1884. doi: 101016/jinjury201407029.
  24. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7):437–446. doi: 105435/JAAOS-22-07-437.
  25. Hong G, Cong-Feng L, Hui-Peng S, et al. Treatment of diaphyseal forearm nonunions with interlocking intramedullary nails. Clin Orthop Relat Res. 2006;450:186–192. doi: 101097/01blo00002144448764575.
  26. Visna P, Beitl E, Pilny J, et al. Interlocking nailing of forearm fractures. Acta Chir Belg. 2008;108(3):333–338. doi: 10.1080/00015458.2008.11680232.
  27. Hofmann A, Hessmann MH, Rudig L, et al. Intramedullary osteosynthesis of the ulna in revision surgery. Unfallchirurg. 2004;107(7):583–592. (In German.) doi: 10.1007/s00113-004-0790-2.
  28. Лазарев А.Ф., Ильин А.А., Солод Э.И., Какабадзе М.Г. Оперативное лечение дефектов длинных трубчатых костей методом опорной каркасной металлопластики. Травматология и ортопедия России. 2006;(2):183–184. [Lazarev AF, Il’in AA, Solod EI, Kakabadze MG. Surgical treatment of defects of long tubular bones using the method of supporting frame metalplasty. Travmatologiya i ortopediya Rossii. 2006;(2):183–184. (In Russ.)]
  29. Saka G, Saglam N, Kurtulmus T, et al. Treatment of diaphyseal forearm atrophic nonunions with intramedullary nails and modifed Nicoll’s technique in adults. Acta Orthop Traumatol Turc. 2014;48(3):262–270. doi: 10.3944/AOTT.2014.3259.
  30. Тихилов Р.М., Кочиш А.Ю., Лушников С.П. Новый способ одномоментной несвободной пластики двумя кровоснабжаемыми костными аутотрансплантатами при ложных суставах обеих костей предплечья. Травматология и ортопедия России. 2010;(1):89–93. [Tikhilov RM, Kochish AYu, Lushnikov SP. A new method of one-stage non-free plasty with two blood-supplied bone autografts for false joints of both forearm bones. Travmatologiya i ortopediya Rossii. 2010;(1):89–93. (In Russ.)]
  31. Idrissi KK, Galiua F. Non-vascularized fibular graft as salvage technique for forearm reconstruction. Chir Main. 2010;29(2):118–120. doi: 10.1016/j.main.2010.01.004.
  32. Kamrani RS, Farhoud AR, Nabian MH, Farhadi L. Treatment of nonunion of forearm bones using radial forearm bone flap. Trauma Mon. 2015;20(4):e22622. doi: 105812/traumamon22622.
  33. Середа А.П. Применение блокируемых компрессирующих пластин при замещении дефектов костей предплечья: Автореф. дисс … канд. мед. наук. М., 2008. 178 с. [Sereda AP. Primenenie blokiruemykh kompressiruyushchikh plastin pri zameshchenii defektov kostei predplech’ya. [dissertation abstract]. Moscow; 2008. 178 p. (In Russ.)]
  34. Елдзаров П.Е. Лечение псевдоартрозов костей предплечья методом Илизарова. Хирургия. 2012;(8):60–64. [Eldzarov PE. Treatment of pseudoarthrosis of the forearm bones by the Ilizarov method. Khirurgiya. 2012;(8):60–64. (In Russ.)]
  35. Orzechowski W, Morasiewicz L, Dragan S, et al. Treatment of non-union of the forearm using distraction-compression osteogenesis. Ortop Traumatol Rehabil. 2007;9(4):357–365.
  36. Борзунов Д.Ю., Соколова М.Н. Методические принципы замещения дефектов костей предплечья с использованием технологий чрескостного остеосинтеза. Травматология и ортопедия России. 2010;(3):103–110. [Borzunov DYu, Sokolova MN. Methodical principles for replacing forearm bone defects using transosseous osteosynthesis technologies. Travmatologiya i ortopediya Rossii. 2010;(3):103–110. (In Russ.)]
  37. Walker M, Sharareh B, Mitchell SA. Masquelet reconstruction for posttraumatic segmental bone defects in the forearm. J Hand Surg Am. 2019;44(4):342e1–342e8. doi: 101016/jjhsa201807003.
  38. Devendra A, Velmurugesan PS, Dheenadhayalan J, et al. One-bone forearm reconstruction: a salvage solution for the forearm with massive bone loss. J Bone Joint Surg Am. 2019;101(15):e74. doi: 102106/JBJS1801235.
  39. Пусева М.Э., Кинаш И.Н., Верхозина Т.К. Преимущества стержневой фиксации при диафизарных переломах костей предплечья по данным реовазографии. Бюллетень ВСНЦ СО РАМН. 2014;(6):34–38. [Puseva ME, Kinash IN, Verkhozina TK. Advantages of rod fixation in diaphyseal fractures of the forearm bones according to rheovasography data. Byulleten’ VSNTs SO RAMN. 2014;(6):34–38. (In Russ.)]
  40. Bousso A, Ndiaye A, Diémé C, et al. Malunion of fractures of the midshafts of the radius and ulna in adults. A series of 10 cases. Chir Main. 2007;26(3):288–292. (In French.) doi: 10.1016/j.main.2007.09.003.
  41. Capo JT, Hashem J, Orillaza NS, et al. Treatment of extra-articular distal radial malunions with an intramedullary implant. J Hand Surg Am. 2010;35(6):892–899. doi: 10.1016/j.jhsa.2010.02.032.
  42. Chia DS, Lim YJ, Chew WY. Corrective osteotomy in forearm fracture malunion improves functional outcome in adults. J Hand Surg Eur. 2011;36(2):102–106. doi: 10.1177/1753193410380585.
  43. Sharma H, Khare GN, Singh S, et al. Outcomes and complications of fractures of distal radius (AO type B and C): volar plating versus nonoperative treatment. J Orthop Sci. 2014;19(4):537–544. doi: 10.1007/s00776-014-0560-0.
  44. Bushnell BD, Bynum DK. Malunion of the distal radius. J Am Acad Orthop Surg. 2007;15(1):27–40. doi: 10.5435/00124635-200701000-00004.
  45. Leong NL, Buijze GA, Fu EC, et al. Computer-assisted versus non-computer-assisted preoperative planning of corrective osteotomy for extra-articular distal radius malunions: a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:282. doi: 10.1186/1471-2474-11-282.
  46. Goldfarb CA, Ricci WM, Tull F, et al. Functional outcome after fracture of both bones of the forearm. J Bone Joint Surg Br. 2005;87(3):374–379. doi: 10.1302/0301-620x.87b3.15509.
  47. Nagy L, Jankauskas L, Dumont CE. Correction of forearm malunion guided by the preoperative complaint. Clin Orthop Relat Res. 2008;466(6):1419–1428. doi: 10.1007/s11999-008-0234-3.
  48. Yörükoğlu AC, Demirkan AF, Akman A, et al. The effects of radial bowing and complications in intramedullary nail fixation of adult forearm fractures. Eklem Hastalik Cerrahisi. 2017;28(1):30–34. doi: 105606/ehc201705.
  49. Schnapp L, Colakoglu S, Couceiro J, et al. Forearm shortening impact on pronation and supination. J Hand Surg Asian Pac. 2019;24(3):289–296. doi: 101142/S242483551950036X.
  50. Trousdale RT, Linscheid RL. Operative treatment of malunited fractures of the forearm. J Bone Joint Surg Аm. 1995;77(6):894–902. doi: 10.2106/00004623-199506000-00010.

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