gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

One-bone forearm technique for chronic post-traumatic forearm instability: a case report

Meeting Abstract

  • presenting/speaker Inma Puig De La Bellacasa - Hospital Universitari Mutua Terrassa, Terrassa, Spain
  • Saioa Quintas - Hospital Universitari Mutua Terrassa, Terrassa, Spain
  • Jordi Salvador - Hospital Universitari Mutua Terrassa, Terrassa, Spain
  • Pablo Castillon - Hospital Universitari Mutua Terrassa, Terrassa, Spain
  • Javier Abarca - Hospital Universitari Mutua Terrassa, Terrassa, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1492

doi: 10.3205/19ifssh0078, urn:nbn:de:0183-19ifssh00784

Published: February 6, 2020

© 2020 Puig De La Bellacasa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives/Interrogation: To present a case of severe longitudinal instability treated by one-bone forearm technique with good functional and painless result.

Is one-bone forearm (OBF) technique an effective salvage procedure in patients with longitudinal forearm instability?

Methods: We present a 52-year-old patient with longitudinal forearm instability secondary to a traumatic accident 30 years ago. She had suffered a subtotal amputation of the left hand with a severe neurovascular injury associated to ulnar open fracture that produced severely impaired hand with little grip function but well tolerated for daily activities. 3 years ago she consulted to our hand unit because of severe lateral elbow pain secondary to a cronic non union ulna fracture and forearm instability. Xrays showed an elbow ostheoarthritis with radiocapitellar impaction. She was managed surgically with a proximal radio-ulnar synostosis. 8 months later, the patient presented a stress fracture in the middle shaft of the radius, secondary to excessive torque forces that was treated with an open reduction and internal fixation in more pronation with a good result in terms of radiological healing, pain-free, good range of motion. She doesn't need further intervention.

Results and Conclusions: OBF is the ultimate salvage procedure for a forearm instability. The procedure attempts to create a single, stable, bone bridge between the ulnohumeral and radiocarpal joints to rescue a chronically unstable forearm. The postraumatic etiology, is the one with higher complication rates because of multiple prior surgical procedures. Despite some published series, it is an uncommon procedure and there is no clear agreement regarding the best indication, which is a symptomatic, angular, axial or rotational radioulnar instability in the setting of segmental bone loss or refractory non union. There is either no consens in which technique to use. Autologous bone grafting at the fusion site is highly recommended. The best rotational position of the fusion is at neutral or 10 degrees of pronation, although this is something that must be treated with the patient.

The OBF tecnique provides a stable forearm with good functional and cosmetic results as well as patient satisfaction. This reconstructive technique has a high complications rate, but once is healed appears to be a satisfactory option in extremities without many alternatives.