Treatment of Distal Radius Fracture Nonunion With Posterior Interosseous Bone Flap

Background: Nonunion of distal radius fractures is disabling. Treatment is difficult and the results are not predictable. However, posterior interosseous bone flap (PIBF) has been successful in treating forearm nonunion. Objectives: To treat distal radius fracture nonunion with PIBF as a new procedure. Patients and Methods: This prospective non-randomized cohort study was performed at two hospitals in Tehran between January 2011 and September 2015. PIBFs were applied in nine patients (10 nonunions) with a mean age of 55 years. Union success rate, grip strength, wrist range of motion, and forearm rotation were then evaluated. Results: Although four of the patients had a history of infection, all participants achieved fracture union at a mean time of 3.8 months. Grip strength improved by 12.4 kg. There was also 36 degrees improvement in wrist flexion, 20 degrees improvement in wrist extension, 60 degrees improvement in forearm supination, and 46 degrees improvement in forearm pronation. The range of motion and grip strength improvements were significant. Conclusions: Pedicled PIBF is a new option for treating distal radius fracture nonunion. The results are predictable in achieving union and good function, and this technique can be successfully used in cases with extensive soft-tissue damage or infection.