|
Year |
2005 |
|---|---|
|
Question Number |
178. |
|
Category |
Musculoskeletal Trauma |
Question
A 22-year-old man reports forearm pain with activity after treatment of a comminuted both bone forearm fracture 6 months ago. Current radiographs are shown in Figure 60. Treatment at this time should consist of
1- continued observation.
2- removal of the nail and a cast brace.
3- autogenous bone grafting and a cast brace.
4- reamed exchange nailing.
5- removal of the nail, plate osteosynthesis, and bone graft
Figures
Answer (click for answer)
PREFERRED RESPONSE: 5
Explanation:
The patient has nonunion of his ulnar shaft fracture with a segmental defect. This should be treated with nail removal, plate fixation, and autogenous bone grafting. According Ring and Jupiter’s article above, all 35 patients with nonunion and segmental defects of forearm fractures healed their fractures with plate fixation and autogenous bone grafting, and this should be considered the treatment of choice.
Reference: RECOMMENDED READINGS: Ring D, Allende C, Jafarnia K, et al: Ununited diaphyseal forearm fractures with segmental defects: Plate fixation and autogenous cancellous bone-grafting. J Bone Joint Surg Am 2004;86:2440-2445.
Street DM: Intramedullary forearm nailing. Clin Orthop 1986;212:219-230.
