Fracture-related and implant-specific factors influencing treatment results of comminuted diaphyseal forearm fractures without bone grafting.

INTRODUCTION: Recommendations regarding the application of primary autologous bone grafting in the surgical treatment of comminuted diaphyseal forearm fractures are conflicting. Some recent studies suggested that there is no difference in the union rate between simple and comminuted forearm fractures and that the use of bone grafting in the treatment of these fractures is therefore not necessary. Our hypothesis was that among comminuted forearm fractures there is a small group of fractures with a very large extent of comminution that heal with a significantly lower union rate and a prolonged time to union compared with other fractures. We believe that in these fractures bone grafting could help to reduce the time to union and further decrease the rate of nonunion.

MATERIALS AND METHODS: We reviewed the results of the treatment of 214 consecutive patients who sustained 319 diaphyseal fractures of forearm bones. To prove our hypothesis, union rate and time to union in fractures with different extents of comminution were compared. All fractures were treated by open reduction and internal fixation with plates without the use of bone grafting. In addition, the study evaluated other factors that could influence the union rate and time to union in observed fractures.

RESULTS: Separate analysis of union rate and time to union in fracture groups with different extents of comminution confirmed our hypothesis only partially. Although we proved that fractures with bone loss greater than two-thirds of the diameter of the diaphysis had a significantly prolonged time to union, we could not demonstrate a significant difference in the union rate between groups. Based on these findings, we believe that primary autologous bone grafting of comminuted diaphyseal forearm fractures is not necessary in most cases. If used, its application should be reserved only for fractures where the bone loss exceeds two-thirds of the diameter of the diaphysis. Such fractures are rare; in our study, they accounted for only 5% of all fractures.

CONCLUSION: The most important factors found to influence the union rate and time to union were stability of fixation and type of plate used for fixation.