AL Kersh MA, Ali AS, Mahran MA, Ashoub M (2019) Management Protocol of Infected Non-Union of Diaphyseal Forearm Fractures by Using External Fixation Over Intramedullary Nailing. Int Arch Orthop Surg 2:012.


© 2019 AL Kersh MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESS DOI: 10.23937/2643-4016/1710012

Management Protocol of Infected Non-Union of Diaphyseal Forearm Fractures by Using External Fixation Over Intramedullary Nailing

Mohamed Ahmed AL Kersh, MD*, Ahmed Said Ali, MD, Mahmoud A Mahran, MD, (MRCS UK) and Mostafa Ashoub, MD

Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt



There are no reported series that specifically deal with repair of infected nonunion of the diaphysis of the forearm bones. We sought to determine whether a standardized treatment protocol we have utilized for 21 patients from 2014 to 2018 results in a high union rate, resolution of infection, and a good functional outcome.


The study cohort included fourteen male and seven female patients who presented to our hospital setting with an infected nonunion of the diaphysis of the radius or ulna. Every patient had a minimum of 2-year follow-up. The average patient age was 35.3 years (range 21-45). Thirteen patients had initially fractured both the radius and ulna. six patients had an isolated radius fractures, and two patients had fracture ulna alone. All patients underwent a protocol that combines aggressive surgical debridement associated with definitive fixation by intramedullary flexible nail and external fixation in the same session followed by after tricortical iliac crest bone grafting for segmental defects after 6 weeks. We sought to report our success rate of nonunion repair, number of re-interventions, complication rate, final ROM, and the ability to eradicate the infection using this treatment regimen.


At follow-up, all patients had fully united and the infection has been resolved with at least 50º of supination/pronation and 30-130º of flexion/extension arc. The average time to union was 131 days (range 100-183 days).


The results of this study indicate that, our standard protocol for treatment of infected nonunion of the shafts of the radius and ulna is reliable at obtaining fracture union with a good functional result, while also resolving the infection.