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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 124-126

Single bone forearm for chronic osteomyelitis of lower third radius


Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

Date of Web Publication14-Dec-2017

Correspondence Address:
Dr. Alok Chandra Agrawal
H-2, Sector-2 Agrasen Nagar, Raipura, Raipur - 492 013, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_31_17

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  Abstract 


The single bone forearm is a reconstructive procedure for the forearm when other options are not viable and sacrifice of one forearm bone; usually, the radius is necessary to save the forearm. The procedure sacrifices supination and pronation also but it gives a painless stable forearm. We are reporting a case of a 40-year-old female who had chronic osteomyelitis of the distal radius and was treated by single bone forearm surgery.

Keywords: Chronic osteomyelitis, radius, single bone forearm


How to cite this article:
Agrawal AC. Single bone forearm for chronic osteomyelitis of lower third radius. J Orthop Traumatol Rehabil 2017;9:124-6

How to cite this URL:
Agrawal AC. Single bone forearm for chronic osteomyelitis of lower third radius. J Orthop Traumatol Rehabil [serial online] 2017 [cited 2021 Feb 25];9:124-6. Available from: https://www.jotr.in/text.asp?2017/9/2/124/220767




  Introduction Top


Single bone forearm also called as one bone forearm is indicated as a salvage procedure for chronic osteomyelitis of the lower third radius especially if it has also destroyed the lower end of ulna and the wrist joint. The procedure was performed initially by Hey Groves in 1921 followed by its use in bone loss following trauma, infection, tumors of distal radius, radial club hand, and also for forearm instability.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] The advantages of the procedure as described include wrist function, growth of the forearm in a child, a strong forearm, and absence of pain. The only precaution while doing the procedure includes the position of the forearm to be maintained depending on patient's choice in supination, mid prone or functional position, and full pronation. We are reporting a case in which the wrist and ulna were also destroyed secondary to chronic osteomyelitis of the distal third radius with a shortening of the forearm muscles giving an appearance of Volkmann ischemic contracture.


  Case Report Top


A 40-year-old female reported to us with a chronic discharging sinus in the right distal forearm since 3 years. There was a history of fall followed by a massage and then a swelling with pain, which got relieved with purulent discharge coming out. The discharge never stopped in these 3 years although there were waxing and waning of symptoms. Her blood count suggested infection with hemoglobin 10.2; total leukocytes count 7400, differential leukocyte count N 62, L38, and erythrocyte sedimentation rate 30. A radiograph of her right forearm and wrist showed chronic osteomyelitis of the distal radius metaphysis with sequestrum formation, lower end of radius broken with intra-articular extension, lower end of ulna eaten up and a Galeazzi fracture-dislocation appearance [Figure 1].
Figure 1: Radiograph of the right forearm and wrist showing chronic osteomyelitis of the distal radius metaphysis with sequestrum formation, lower end of radius broken with intra-articular extension, lower end of ulna eaten up, and a Galeazzi fracture-dislocation appearance

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The surgical options discussed were the two staged Masculets (French) technique of induced membranes, two-stage debridement and antibiotic impregnated beads followed by bone grafting and wrist fusion and a single stage debridement with a single bone forearm as the wrist and lower end of radius and ulna all were destroyed.

The procedure was carried out as a single stage wound debridement, removal of sequestrum, removal of the intra-articular fragments of the radius, and single bone forearm with the ulna stabilized with a 3 mm K-wire [Figure 2]. The patient had an uneventful course with no further infection and fusion at ulnocarpal junction [Figure 3].
Figure 2: Radiograph showing single bone forearm with the ulna stabilized with a 3mm K-wire

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Figure 3: Radiograph showing fusion at ulnocarpal junction

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  Discussion Top


Single bone forearm patients were classified traditionally into two groups based on etiology: (1) post-traumatic; (2) nontraumatic etiology.[1] Based on our experience, we have classified single bone forearm into congenital, traumatic, inflammatory including infective pathologies, and neoplastic etiologies. Although superior functional and patient-rated outcomes have been observed when single bone forearm surgery has been done to treat forearm instability secondary to congenital or oncological disorders it remains a good salvage option when done for postinfective and posttraumatic causes.[1],[2],[3]

The advantage of single bone surgery is its potential to provide a more predictable postoperative course with respect to pain, infection eradication, compartmental pressure reduction, better hand function and stability, especially in younger and more active patients. The single bone forearm is considered useful as a last resort in posttraumatic and postinfective bone loss including segmental bone loss.[12],[13],[14],[15] The problems faced by the patient during and after treatment include nonunions, impingement, pain, shortening, restriction of motion and infection.

Our case was unique in having the lower end of ulna destroyed and subluxated making wrist function also painful and infection destroying the distal radius metaphysis with sequestrum formation. The French technique of bone grafting could not be used in this case due to destroyed lower end of ulna with subluxation and associated septic arthritis of the hip. A single, simple salvage saved the patient from an otherwise amputation or nonfunctional reconstruction.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Groves EW. On Modern Methods of Treating Fractures. 2nd ed. Bristol: John Wright and Sons Ltd.; 1921. p. 320.  Back to cited text no. 1
    
2.
Castle ME. One-bone forearm. J Bone Joint Surg Am 1974;56:1223-7.  Back to cited text no. 2
    
3.
Peterson CA 2nd, Maki S, Wood MB. Clinical results of the one-bone forearm. J Hand Surg Am 1995;20:609-18.  Back to cited text no. 3
    
4.
Jacoby SM, Bachoura A, Diprinzio EV, Culp RW, Osterman AL. Complications following one-bone forearm surgery for posttraumatic forearm and distal radioulnar joint instability. J Hand Surg Am 2013;38:976-82.e1.  Back to cited text no. 4
    
5.
Haque IU. The production of a one-bone forearm as a salvage procedure after haematogenous osteomyelitis. A case report. J Bone Joint Surg Br 1982;64:454-5.  Back to cited text no. 5
    
6.
Kitano K, Tada K. One-bone forearm procedure for partial defect of the ulna. J Pediatr Orthop 1985;5:290-3.  Back to cited text no. 6
    
7.
Arai K, Toh S, Yasumura M, Okamoto Y, Harata S. One-bone forearm formation using vascularized fibula graft for massive bone defect of the forearm with infection: Case report. J Reconstr Microsurg 2001;17:151-5.  Back to cited text no. 7
    
8.
Pal JN, Banik R. Monoaxial distraction of ulna to second metacarpal followed by single bone forearm in massive post infective radial bone loss. Indian J Orthop 2012;46:685-9.  Back to cited text no. 8
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9.
Manojlovic R, Tulic G, Kadija M, Vucetic C, Tabakovic D, Bumbasirevic M. Forearm reconstruction after loss of radius: Case report. Srp Arh Celok Lek 2013;141:100-3.  Back to cited text no. 9
    
10.
Murray RA. The one-bone forearm: A reconstructive procedure. J Bone Joint Surg Am 1955;37:366-70.  Back to cited text no. 10
    
11.
Jupiter JB, Fernandez DL, Levin LS, Wysocki RW. Reconstruction of posttraumatic disorders of the forearm. J Bone Joint Surg Am 2009;91:2730-9.  Back to cited text no. 11
    
12.
Agrawal AC. Single bone forearm in post traumatic and post infective complicated forearm. J Orthop 2017;4:26-8.  Back to cited text no. 12
    
13.
Agrawal AC. Single bone forearm for limb salvage following excision of Ewing's sarcoma from the radius diaphysis. J Orthop 2017;4:33-5.  Back to cited text no. 13
    
14.
Lee SJ, Jazrawi LM, Ong BC, Raskin KB. Long-term follow-up of the one-bone forearm procedure. Am J Orthop (Belle Mead NJ) 2000;29:969-72.  Back to cited text no. 14
    
15.
Krishna RK, Aradhana TR, Srikantha KS, Preetham N. Management of bone defect in forearm by creating one bone forearm: A case report. Indian J Orthop Surg 2015;1:79-81.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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