REVISION OF THE UNUNITED ONE-BONE FOREARM

Between 1975 and 1995, 7 patients were surgically treated for persiste nt forearm pain following previously unsuccessful attempts of construc ting a radioulnar synostosis using interosseous bone grafting with eit her cross screw or pin fixation. These prior reconstructive procedures were salvage operations to address symptomatic radioulnar instability . The time interval between index operation and revision surgery was a mean of 12.6 months (range, 4-36 months). The postoperative follow-up period averaged 29.7 months (range, 11-61 months). To address these f ailed radioulnar arthrodeses, plate osteosynthesis and aggressive bone grafting were used in 5 of 7 patients (group 1) (4 with autologous gr aft and 1 with demineralized bone matrix). Union was achieved in all 5 patients after a single revision operation. Radiographic evidence of solid union was seen at approximately 4 months. In the remaining 2 pat ients (group 2), revision synostosis procedures were performed; these involved local bone grafting and repeat transverse screw fixation in 1 patient and iliac crest bone grafting alone in the other. One of thes e 2 patients progressed to union; the other had a persistent symptomat ic fibrous union. The 5 patients in group 1 reported symptomatic relie f, while the 2 patients in group 2 were dissatisfied. There were no po stoperative complications in our series. Based on our findings, we adv ocate abundant bone grafting and plating for rigid internal fixation i n failed radioulnar synostosis procedures. (J Hand Surg 1998;23A:1091- 1096. Copyright (C) 1998 by the American Society for Surgery of the Ha nd.).