Diaphyseal forearm fractures treated with and without bone graft

Background: The purpose of this study was to determine whether the acute bo ne grafting of diaphyseal forearm fractures decreases the incidence of nonu nion and reduces the time to union. Although the traditional treatment of c omminuted radius and/or ulnar shaft fractures involves bone graft, a recent report called into question this practice. Patients: A database search was used to identify all acute diaphyseal forea rm fractures presenting to an urban Level I trauma center between 1988 and 1996, All radius and/or ulnar shaft fractures, as well as all Monteggia and Galeazzi fracture-dislocations, in patients with closed physes were includ ed. The charts and operative reports were available for 64 diaphyseal forea rm fractures in 49 patients. Fifty-six fractures were followed for at least 1 year beyond clinical and radiographic union. The injuries were treated w ith open reduction and plate fixation by experienced orthopedic traumatolog ists. All noncomminuted fractures were treated without bone graft. For the comminuted fractures, the decision to use bone graft was left to the discre tion of the operating surgeon. Results: Overall, 55 of 56 fractures (98%) achieved union at a mean of 49 d ays (range, 19-123 days), with the only nonunion occurring in a patient wit h a closed, noncomminuted Galeazzi injury. Among the 20 noncomminuted fract ures, all of which were treated without bone graft, 19 (95%) achieved union at a mean of 50 days (range, 19-102 days). Among the 36 comminuted fractur es, all 25 treated without bone graft achieved fusion at an average of 50 d ays (range, 20-123 days) and all 11 treated with bone graft achieved union at an average of Jj days (range, 22-67 days). No statistically significant difference in the incidence of nonunion or time to union was noted between fractures that were treated with and without bone graft. Conclusion: Acute bone grafting of diaphyseal forearm fractures did not aff ect the union rate or the time to union.