Operative Treatment for Nonunions of Distal Radial Fracture - A Report of 7 Cases -

Ho Jung Kang; Han Kook Yoon; Hong Kee Yoon; Chang Wook Han; Sung Hoon Jung; Soo Bong Han

doi:10.4055/jkoa.2008.43.3.322

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Kang, Yoon, Yoon, Han, Jung, and Han: Operative Treatment for Nonunions of Distal Radial Fracture - A Report of 7 Cases -

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(3): 322-328.

Published online: 30 June 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.3.322

Operative Treatment for Nonunions of Distal Radial Fracture - A Report of 7 Cases -

Ho Jung Kang, M.D., Han Kook Yoon, M.D.^*, Hong Kee Yoon, M.D.^*, Chang Wook Han, M.D., Sung Hoon Jung, M.D., Soo Bong Han, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

^*Department of Orthopaedic Surgery, National Health Insurance Corporation Ilsan Hospital, Ilsan, Korea.

Address reprint requests to Han Kook Yoon, M.D. Department of Orthopedic, National Health Insurance Corporation Ilsan Hospital, 1232, Baekseok-dong, Ilsan-gu, Goyang 411-360, Korea. Tel: +82.31-900-0540, Fax: +82.2-900-0343, hangugi@gmail.com

Abstract

Purpose

To report the treatment results of 7 cases of distal radius nonunion with a review of the relevant literature.

Materials and Methods

Seven patients treated with an autoiliac bone graft and rigid internal fixation for nonunion of the distal radius were analyzed retrospectively for the cause of injury, the factors affecting nonunion, radiological findings, treatment method and complications. The results were analyzed radiologically using Kreder's method and functionally using the Anderson' protocols.

Results

Union was achieved in all cases after a mean period of 19 weeks. The functional result of treatment at the last follow-up was excellent in 4 cases and satisfactory in 3 cases. The probable factors of nonunion were instability of the fracture site in three cases, type II or III open fracture in 2 cases, postoperative infection in one case and idiopathic in one case.

Conclusion

Infection control using a stepwise operation, rigid internal fixation and autogenous iliac bone graft showed satisfactory results in distal radius nonunion, which had developed in those with severe open fractures, postoperative infection, instability on the fracture site and associated distal ulnar fracture.

Keywords: Distal radius, Nonunion, Bone graft, Internal fixation

Figures and Tables

Fig. 1

A line perpendicular to the central long axis of the radius is drawn to the level of the most distal radial articular surface (A), to the level of the ulnar margin of the distal radial articualr surface (B) and to the level of the distal ulnar articular surface (C). RL, radial length; UV, ulnar variance.

Fig. 2

(A), (B) Preoperative radiograph of a 23-year-old male patient shows nonunion of a distal radius fracture. (C), (D) Postoperative radiograph taken 14 weeks after surgery shows good union.

Fig. 3

(A), (B) Plane radiographs of a 23-year-old male patient taken 8 months after the fracture, which shows nonunion of the fracture and loosening of the implant. (C), (D) Double plating, autoiliac bone graft and resection of the distal ulna were performed. (E) Postoperative CT scan at 12 months after operation shows good union.

Table 1

Patients Data

^*Right; ^†Fracture; ^‡Closed reduction; ^§Left; ^∥Motor vehicle accident; ^¶External fixation; ^**Open reduction; ^††Non-dominant arm.

Table 2

Treatment Results

^*Opposite site

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