EC Orthopaedics

The aim of this write-up was to decipher why an apparently ‘simple’ forearm fracture would end up with severe initial post-operative complications, requiring multiple interventions for correction.

We therefore reviewed the case of a 41years old man, that we managed by two-staged surgery for an ‘armed’ septic non-union after a previous treatment of a ‘simple’ transverse right forearm fracture. Poor understanding of fracture treatment techniques, non-respect of aseptic measures, poor choice of implants and the non-respect of soft tissues and vascularisation could be responsible for the development of septic non-union in this patient, with an apparently simple appearing fracture.

Forearm fractures should therefore not be minimised based on their appearances, but should be adequately evaluated, treatment corrected planned and follow-up rightly pursued.

 Keywords: Simple Forearm Fracture; Septic Non-Union; Multiple Interventions

1. Al-Sadek TA., et al. “Diaphyseal fractures of the forearm in adults, plating or intramedullary nailing is a better option for the treatment?” Open Access Macedonian Journal of Medical Sciences 4 (2016): 670‑673.
2. Köse A., et al. “Treatment of radius or ulna diaphysis atrophic non-unions with corticocancellous autograft and intramedullary nailing”. Hand and Microsurgery 8 (2019): 139-150.
3. Perna F., et al. “Two-stage surgical treatment for septic non-union of the forearm”. World Journal of Orthopedics 6 (2017): 471‑477.
4. Kloen P., et al. “Management of forearm nonunions: current concepts”. Strategies in Trauma and Limb Reconstruction 1 (2012): 1‑11.
5. Lapcin O., et al. “Evaluation of outcomes in aseptic non-unions of the forearm bones in adults treated with LCP and autograft”. Ulusal Travma ve Acil Cerrahi Dergisi 3 (2016): 283‑289.
6. Dhar SA., et al. “Management of infected nonunion of the forearm by the Masquelet technique”. Strategies in Trauma and Limb Reconstruction 1 (2019): 1‑5.
7. Liu T., et al. “Infected forearm nonunion treated by bone transport after debridement”. BMC Musculoskeletal Disorders1 (2013): 273.
8. Arciola CR., et al. “Implant infections: adhesion, biofilm formation and immune evasion”. Nature Reviews Microbiology 7 (2018): 397‑409.
9. Rozis M., et al. “Orthopedic implant-related biofilm pathophysiology: a review of the literature”. Cureus 6 (2021).
10. H Boussakri., et al. “Nonunion of fractures of the ulna and radius diaphyses: clinical and radiological results of surgical treatment”. MOJ2 (2016): 27‑34.