Possible causes of failure in treatment of forearm bone shaft fractures - own experience.

BACKGROUND Non-surgical treatment of forearm shaft fractures in adults is associated with a high incidence of non-union. Operator errors during surgery also often result in bone union complications. We attempted to identify the errors made during the treatment or other factors that might influence the development of forearm shaft union complications. MATERIALS AND METHODS We have analysed the causes of 67 cases of non-union in 53 patients (17 women and 36 men), aged 18 to 85 years. Thirty-five patients were treated by open repositioning and fixation with plates and screws, 11 patients were treated by closed or open reposition and stabilization with Kirschner wires, and 4 patients had closed reposition and immobilization in a plaster cast. Other methods were used in 3 patients. RESULTS In the group treated by open reposition and plate fixation, we found the following complications that might impede bone union: plate fracture, technical errors, screw loosening, bone inflammation, and other complications. In the group treated by closed or open repositioning and stabilization with Kirschner wires, we found the following factors that might impede bone union: open fractures, inaccurate fracture repositioning and inappropriately inserted Kirschner wires. CONCLUSIONS Using rigid fixation, for example with a plate and screws, and avoidance of technical errors seem to be the most appropriate measures helping to decrease the risk of non-union during treatment of a fracture of both forearm shafts.