Management of Infected Both-Bone Forearm Nonunion with Ulnar Plating and Radial Onlay Bone Graft )A Case Report(

Babaei, Reza; Gharibi, Mina; Karami, َAyda; Heidari, Seiied Hossein

doi:10.22034/ijos.2025.243332

Management of Infected Both-Bone Forearm Nonunion with Ulnar Plating and Radial Onlay Bone Graft )A Case Report(

Document Type : Case Report

Authors

Reza Babaei ¹

Mina Gharibi ²

َAyda Karami ¹

Seiied Hossein Heidari ¹

¹ Orthopedic Rehabilitation Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

² Department of Operating Room, School of Nursing and Midwifery, Shiraz University of Medical Sciences

10.22034/ijos.2025.243332

Abstract

Abstract
Infected nonunion of both forearm bones presents significant therapeutic challenges. Conventional methods often involve prolonged stabilization or complex grafting techniques with variable functional outcomes. A 49-year-old diabetic female presented with purulent drainage and failed union after two prior surgeries for open forearm fractures. Radiographs confirmed infected nonunion with retained hardware. A staged protocol was performed as such: (1) Radical debridement, ulnar plating, and antibiotic-cement spacer placement in the radial defect; (2) After interim antibiotics, spacer wasremoved and radius reconstructed with tricortical iliac crest autograft, fixed with screws, and augmented by cancellous grafting. At 24-week follow-up, radiographic union was achieved with no infection recurrence. Approximately 90% of contralateral forearm range of motion was restored, with no donor site complication. This approach—combining immediate ulnar stabilization with staged radial reconstruction using the Masquelet technique—effectively resolved infection and restored function in complex both-bone nonunion. It represents a strategic balance of mechanical and biological principles for challenging upper limb reconstruction.

Keywords

Ununited Fractures

Osteomyelitis

Radius Fractures

Ulna Fractures

Subjects