Treatment of diaphyseal forearm atrophic nonunions with intramedullary nails and modified Nicoll's technique in adults

The aim of this study was to evaluate the outcome of tricorticocancellous autologous bone grafting with intramedullary forearm nails in the treatment of radius or ulna aseptic nonunion. The study included 8 patients (mean age: 39 years; range: 19 to 55 years) who underwent plate-screw osteosynthesis for the treatment of nonunion (6 ulna, 2 radius) following forearm fracture. In all cases, the length of the applied tricortical graft was below 3 cm. Patients were evaluated using the visual analog scale, Grace and Eversmann scale and DASH score. Wrist flexion and extension and postoperative hand and forearm grip strength were assessed. Graft incorporation and union was completed at a mean of 22 (range: 18 to 28) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up ranged from 18 to 52 months. Radiographic union was achieved in all patients. Mean visual analog scale pain score was 1 (range: 0 to 3). Grace and Eversmann ratings were excellent in 5 and good in 3 patients. Mean DASH score was 10.7 (range: 1.7 to 21.7) points. Intramedullary nailing and tricorticocancellous iliac bone block grafting appears to be a technically easy and reliable procedure that enables early postoperative rehabilitation in the treatment of nonunion of the forearm.