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Complications of One-Bone Forearm Surgery
Lee Diprinzio, BS1; Abdo Bachoura, MD1; Sidney M. Jacoby, MD2; A. Lee Osterman, MD1; Randall W. Culp, MD2; (1)Thomas Jefferson University, (2)Thomas Jefferson University Hospital
Thomas Jefferson University Hospital, Philadelphia, PA, USA

Introduction: Forearm instability presents a difficult clinical problem for surgeons. Reconstructive procedures are normally attempted first, trying to maintain the natural anatomy and function of the forearm and bones. When pain and instability persist, salvage procedures are considered, one of the most popular being one-bone forearm (OBF). Long term complications of this procedure have been sparsely studied. We present the functional results and complications in patients with a one-bone forearm.

Materials and Methods: Between 1998 and 2007, we identified 10 patients that underwent this procedure at one surgical center. A chart review was conducted focusing on pre- and post-operative range of motion at the wrist and elbow and grip strength. We also looked at the post-OBF complications and additional forearm procedures performed on these patients.

Results: There were 4 males and 6 females with a mean age of 30.6 years (17-44) at the time of surgery. Patients had a mean follow-up post surgery of 56 months (12-165). Diagnoses included radial head fracture, distal radioulnar joint dislocation, radial shaft fracture, wrist ligament tear, both bone forearm fracture, and congenital abnormality (Hadju-Cheyney Syndrome). The patients had undergone an average of 2.2 procedures (0-4) prior to OBF. The mean preoperative wrist flexion and extension were 53.5o, 53.1 o respectively while the mean postoperative flexion and extension were 52.8 o, 52.1 o. The mean preoperative elbow extension and flexion were 8.1 o, 124.4 o respectively while the mean postoperative extension and flexion were 8.1 o, 123.8 o. The mean preoperative grip strength was 29.1 pounds while the mean postoperative grip strength was 20.1 pounds. 7 of 8 patients underwent additional surgeries, the average being 1.7 procedures (0-6). 4 patients had non-union of the OBF, 5 underwent OBF revision, and 3 had fracture of the OBF post-procedure. 8 patients continued to report pain, either at the wrist, elbow, shoulder, or forearm, post operatively even at final follow-up, although 1 patient reported no pain at all. 2 patients had recorded crepitus in the elbow or forearm, 3 had elbow instability with locking or clicking, and 3 experienced digital paresthesias.

Conclusion: Overall, OBF remains a viable salvage procedure, although complications are expected to develop. In this series, the majority of patients needed additional surgery, with non-union and fracture being fairly common causes. Despite elimination of pronation and supination, wrist and elbow flexion and extension as well as grip strength did not change significantly.

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