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The management of bone defects of the forearm after trauma.

In summary, the authors believe that traumatic bone defects of the diaphyseal forearm, fewer than 6 cm in length, can be well managed with corticocancellous bone grafting, provided the patient has an adequate soft-tissue envelope. In cases of soft-tissue compromise, primary bone grafting is still the treatment of choice, combined with simultaneous soft-tissue coverage. This does not exclude the use of immediate primary shortening. Traumatic bone defects larger than 6 cm can best be managed with osteoseptocutaneous free fibular graft with excellent functional and cosmetic results. The creation of a one-bone forearm is rarely necessary, but remains a treatment option for an otherwise unsalvageable extremity. Osteo-articular defects can be more difficult to manage. Proximal osteo-articular defects of the radial head can be treated with excision or placement of a titanium radial head prosthesis. Distal osteo-articular defects may be better addressed in the case of radial bone loss by primary wrist fusion and, in the ulna, by a primary Darrach or Suave-Kapandji procedure.