A novel technique of ulna strut grafting for post-septic radial clubhand deformity: Case series of 4 patients with review of literature.

BACKGROUND: Though distal end radius fractures are one of the commonest fractures to occur, their nonunions are extremely uncommon. Out of these, post-septic defect nonunions with acquired radial clubhand deformity are even more rare and pose unique problems in management. We present a case series of 4 patients of post-septic radius nonunion with acquired radial clubhand deformity successfully treated with a novel technique of using Ulna Strut grafting for radius defect after ulnar shortening. All 4 patients have a good functional and cosmetic outcomes with radiological union at the cost of minimal limb length discrepancy of the forearm.

METHODS: This is a case series of 4 patients with a retrospective study design and study duration of 3 years from August 2016 till March 2019.4 patients presenting to us with post-septic defect nonunions of radius with an acquired radial clubhand deformity were selected with a mean age of 19.75 years which included 2 males and 2 females.

RESULTS: The mean time for radiological union was 3.125 months. The average range of motion at the wrist joint was 35° of flexion and 50° of extension with average protonation being 47.5° and supination being 75°.There were no subsequent complications reported in these patients except for a minimal limb length discrepancy with satisfactory functional outcomes in all the patients.

CONCLUSION: The use of Ulnar shortening and Ulna strut grafting for the treatment of defect nonunions of radius with acquired clubhand deformity yielded predictable results. It is a simple procedure that does not require additional training, with no additional morbidity of iliac crest or fibula bone grafting and had a minimum complication rate. The technique looks promising in the future, though a study on a larger population would further strengthen the predictability of this unique technique.