The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review

Abstract

Objective: To determine the union rate of forearm fractures where acute bone grafting was recommended but not performed.

Design: Retrospective review.

Setting: Regional level one trauma center.

Patients: The criteria for inclusion in the study were patients with closed growth plates 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 lost to follow-up before radiographic documentation of bone union. The review identified 198 fractures that were eligible for inclusion. Fifteen fractures were excluded.

Intervention: The method of treatment of each fracture was open reduction and plate fixation with or without bone grafting.

Main outcome measurement: Fracture union.

Results: The overall union rate in comminuted, nongrafted forearm fractures (open and closed) was 98% (99/101; 95% confidence interval: 93-100%). The union rate in closed, comminuted, nongrafted forearm fractures was 97% (74/76; 95% confidence interval; 91-100%).

Conclusions: Open reduction and internal fixation of comminuted diaphyseal forearm fractures without bone grafting in this study produced union rates comparable to those reported for open reduction and internal fixation of comminuted forearm fractures with acute bone grafting. This study suggests that routine use of bone grafting in comminuted forearm fractures is not indicated.