THE NECESSITY OF ACUTE BONE-GRAFTING IN DIAPHYSEAL FOREARM FRACTURES - A RETROSPECTIVE REVIEW

Objective: To determine the union rate of forearm fractures where acut e bone grafting was recommended but not per formed. Design: Retrospect ive review. Setting: Regional level one trauma center. Patients: The c riteria for inclusion in the study were patients with closed growth pl ates and a diaphyseal fracture of the radius, ulna, or both (including Monteggia and Galeazzi fracture-dislocations) that were treated with plate fixation, Patients were excluded from the study if they were los t to follow-up before radiographic documentation of bone union. The re view identified 198 fractures that were eligible for inclusion. Fiftee n fractures were excluded. Intervention: The method of treatment of ea ch fracture was open reduction and plate fixation with or without bone grafting. Main Outcome Measurement: Fracture union. Results: The over all union rate in comminuted, nongrafted forearm fractures (open and c losed) was 98% (99/101; 95% confidence interval: 93-100%). The union r ate in closed, comminuted, nongrafted forearm fractures was 97% (74/76 ; 95% confidence interval: 91-100%). Conclusions: Open reduction and i nternal fixation of comminuted diaphyseal forearm fractures without bo ne grafting in this study produced union rates comparable to those rep orted for open reduction and internal fixation of comminuted forearm f ractures with acute bone grafting. This study suggests that routine us e of bone grafting in comminuted forearm fractures is not indicated.