Name of the Procedure:

Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft)

Summary

This surgical procedure involves correcting a bone that has not healed properly (nonunion) or has healed in an incorrect position (malunion) in either the radius or ulna, which are the bones of the forearm. The surgery also includes the use of a bone graft taken from the patient's own body to facilitate proper healing.

Purpose

The procedure addresses issues where a forearm bone (radius or ulna) has failed to heal correctly after a fracture. The goals are to restore proper alignment, promote bone healing, and improve function and mobility in the forearm and wrist.

Indications

• Persistent pain and discomfort in the forearm due to nonunion or malunion.
• Decreased function or range of motion in the wrist or forearm.
• Visible deformity of the forearm.
• Failure of previous treatments, such as casts or braces, to resolve the issue.

Preparation

• Fasting for at least 8 hours before the surgery.
• Stopping certain medications as advised by the doctor.
• Undergoing preoperative assessments, including imaging tests like X-rays or CT scans, and blood work.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Incision: A surgical incision is made over the affected area of the forearm.
3. Realignment: The surgeon repositions the bone fragments into their correct anatomical alignment.
4. Autograft Harvesting: Bone graft material is taken from another part of the patient’s body, typically the hip (iliac crest).
5. Grafting: The harvested bone graft is placed at the site of nonunion or malunion to promote new bone growth.
6. Fixation: Internal fixation devices such as plates, screws, or rods may be used to hold the bones in place.
7. Closure: The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the case.

Setting

The surgery is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical assistants or physician's assistants
• Anesthesiologist
• Operating room nurses
• Scrub technician

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve damage
• Pain or temporary swelling
• Failure of the bone to heal (persistent nonunion)
• Refracture or malalignment
• Risks associated with anesthesia

Benefits

• Relief from pain and discomfort.
• Improved function and mobility of the forearm and wrist.
• Corrected bone alignment and enhanced bone healing.

Recovery

• Postoperative pain management with medications.
• Wearing a cast or splint for several weeks to immobilize the forearm.
• Physical therapy to restore strength and flexibility.
• Follow-up appointments for X-rays and assessments.
• Recovery may take several months, with gradual return to normal activities.

Alternatives

• Non-surgical treatments such as physical therapy, braces, or bone stimulators.
• Other surgical options, depending on the specific case and severity, such as external fixation.

Patient Experience

During the procedure, the patient is under general anesthesia and won't feel anything. Postoperatively, pain and swelling are common but can be managed with medications. Patients may experience some discomfort from the graft donor site. Physical therapy and regular follow-ups are essential aspects of recovery, and gradual improvement in mobility and function can be expected over time.