Infected Gap Non Union of Radius Treated with Modified Nicoll's Technique-A Case Report

A novel technique of ulna strut grafting for post-septic radial clubhand deformity: Case series of 4 patients with review of literature

BACKGROUND

Though distal end radius fractures are one of the commonest fractures to occur, their nonunions are extremely uncommon. Out of these, post-septic defect nonunions with acquired radial clubhand deformity are even more rare and pose unique problems in management. We present a case series of 4 patients of post-septic radius nonunion with acquired radial clubhand deformity successfully treated with a novel technique of using Ulna Strut grafting for radius defect after ulnar shortening. All 4 patients have a good functional and cosmetic outcomes with radiological union at the cost of minimal limb length discrepancy of the forearm.

METHODS

This is a case series of 4 patients with a retrospective study design and study duration of 3 years from August 2016 till March 2019.4 patients presenting to us with post-septic defect nonunions of radius with an acquired radial clubhand deformity were selected with a mean age of 19.75 years which included 2 males and 2 females.

RESULTS

The mean time for radiological union was 3.125 months. The average range of motion at the wrist joint was 35° of flexion and 50° of extension with average protonation being 47.5° and supination being 75°.There were no subsequent complications reported in these patients except for a minimal limb length discrepancy with satisfactory functional outcomes in all the patients.

CONCLUSION

The use of Ulnar shortening and Ulna strut grafting for the treatment of defect nonunions of radius with acquired clubhand deformity yielded predictable results. It is a simple procedure that does not require additional training, with no additional morbidity of iliac crest or fibula bone grafting and had a minimum complication rate. The technique looks promising in the future, though a study on a larger population would further strengthen the predictability of this unique technique.

Modified Boyd's Dual Onlay Bone Graft Technique for 15 Years Old Neglected Nonunion Fracture both Bone Forearm with Severe Angular Deformity: Case Report

Introduction:

Neglected case of nonunion of fracture both bones forearm with deformity is very difficult to manage. Treatment options are minimal. Identifying such a case in literature is also very rare. One such rare case is discussed here.

Case Report:

Here, we present a case of a 65-year-old male patient, who was operated 15 years back for fracture both bones forearm, with 3.5 mm dynamic compression plate. Fracture went into nonunion and plate was broken. The patient presented to us 15 years later in August 2013 with nonunion, broken, and loosened implants and varus deformity of 90°. Implants were removed, sequential correction of deformity was done, using external fixators. After deformity correction was achieved, nonunion was managed by modified Boyd’s dual onlay bone graft technique.

Conclusion:

Modified Boyd’s dual onlay bone graft technique is an effective method in achieving union and restoration of functions, even in patients with resistant nonunion.