Management of Non-United Forearm Fractures in Adults Primarily Fixed by Rush Nail

Abstract

ABSTRACT 

Background:

Non-unions of the radius and ulna shaft cause a severe anatomic and functional impairment. This is related to the disturbance of the inter-osseous membrane and the dysfunction of the adjacent joints elbow and wrist joint. These demanding nonunions require the surgical correction to restore the anatomy of the forearm and to improve function.

Objectives: To prove that using Rush nail fixation of forearm bone fractures may lead to nonunion of these fractures. Fixation by plate and screw with bone graft is the treatment of choice for such non-united fractures

Methods: Twenty six cases of non united forearm fractures, from 20 patients who had a fractures radius and ulna that previously treated by rush nail for fixation were collected, studied and treated in Al-Yarmook Teaching hospital, Red Crescent surgical  Hospital and Al-Imam Ali  general hospital during the period from April 2009 till December 2012. Of the 20 patients treated, 15 were males and 5 were females and the patient ages ranged from 15 years to 50 years with a mean age of 33 years. Our surgical method consisted of resection of the sclerosis end, of the non-union site, removal of the rush nail if present, removal of all interposed soft tissue, opening of the medullary canal, refreshing the two ends of the fracture site, then anatomic restoration of the forearm length, then a dynamic compression plating (DCP) or semi tubular plate with or without bone graft (autologous corticocancellous strips bone graft from the iliac crest) were applied, suction drain left, back slab was done for two weeks then a full pop cast for 3-4 weeks followed by functional brace for 3 weeks with physiotherapy and rehabilitation course for the elbow, wrist and shoulder joint was done. 

Results: Twenty cases ended with excellent result with complete union, good consolidation and a very good movement of the joints near by fractures.  Five cases had a delayed union of the fracture site due to post operative infection in 3 cases or due to large bone defect (3-5 cm) in 2 cases. We had one case failure due to poor condition of the sclerosed ulna that end with plate screws loosening who miss from our follow up

Conclusion: Using Rush nail for fixation of forearm fractures may lead to non -union of these fractures management of such non-union can best be treated by plate and screw fixation with autogenous bone  graft.