Nonunion distal radius fracture – Case series of 6 cases with Review of Literature

Background: Distal radius nonunions are rare but complex problems. They can present with severe disability and functional limitation, however clear guidelines do exist due to sparse literature. We present our experience of 6 cases with review of literature Material and Methods: Retrospective review of 6 cases (4 males and 2 females) was done. Two cases were primarily treated with closed reduction and cast while others underwent surgical procedures ranging from single to 4 procedures. All were treated with open reduction, strut bone grafting using iliac crest bone graft and internal plate fixation. Darrach’s procedure was done in 4 cases and Sauvé-Kapandji in 2 patients after distal radius reconstruction. Supplementary wrist splint or below elbow plaster cast, was given in all cases for 3 wks with gradual mobilization. Results: All patients showed, radiological union at mean 4 months (range 3 to 6 months). Range of flexion extension at wrist and supination and pronation improved over 4 months period in all cases. Grip strength was 30 % weak compared with opposite side in 5 patients. There were no subsequent complications in our series and all patients reported satisfaction with the functional results Conclusions: Nonunion distal radius are rare but respond well to principles of open reduction, strut bone grafting and stable fixation. Distal radio ulna joint requires management in form of either a Sauvé Kapandji procedure (in young patient) or Darrach’s procedure (in older patients) Keywords: nonunion distal radius fracture, open reduction internal fixation, bone grafting, Sauvé Kapandji, Darrach’s procedure.