Comparative analysis of surgical treatments of non-union in forearm fractures

Objective To compare outcomes of non-union in forearm fractures treated with the use of a comprehensive surgical approach considering the injury pattern and localization. Material and methods Based on treatment approaches the cases were categorized into 3 groups with proximal forearm fractures (group I, n = 28; 33.8 %), mid-shaft and distal forearm fractures (group II, n = 32; 38.5 %), and controls (group III, n = 23; 27.7 %). Group I included patients with hypertrophic nonunion (HTNU) of the forearm bones treated with bone graft and plating. Group II consisted of atrophic nonunion, HTNU of the forearm bones repaired with the Ilizarov external fixation. A single 3 mL local injection of autologous bone marrow and a kukumazim solution of 50 PU were used to induce bone fusion in the patients of the two groups. The control group included non-unions with no considerations to the fracture pattern and localization. All patients underwent physical, radiological examinations and laboratory tests. Results The control group showed 8.7 % poor and 69.5 % good outcomes at a long term, whereas 3.6 % results were rated as poor and 82.1 % as good in group I, with 3.1 % poor and 87.6 % good outcomes in group II. The ratings can be associated with a differentiated surgical approach considering the injury pattern and localization, the use of kukumazim proteolytic enzymes and autologous bone marrow injection. Conclusion Optimization of surgical treatments and considerations for injury pattern and localization allowed for a 2.8-time (3.1 %) decrease in poor outcomes and a 30 % reduction in the limb immobilization period.