Malunion/Nonunion of Radius and Ulna Shaft Fractures

Radius and ulna shaft malunions and nonunions are uncommon occurrences in this age of  open reduction and internal fixation (ORIF). Malunions can be thought to occur in radius and  ulna shaft fractures managed without operative intervention or internal fixation. Nonunions    can be thought of as failure of union, for various reasons, after surgical intervention. However,  both malunions and nonunions can occur in conservatively treated radius and ulna fractures.  In a 1949 study1 of 41 radius and ulna fractures, 29% had satisfactory results and 71% had  unsatisfactory results. Five patients went on to nonunion, a 12% incidence. A later review2 of  41 distal third radial shaft fractures (Galeazzi or Piedmont variants) showed that 38 were  treated with closed reduction and casting, and had a 92% failure rate. A number of these cases  subsequently went on to surgical intervention. This paper will define anatomic and  biomechanic correlations of malunions and nonunions of radius and ulna shaft fractures and  provide an overview of treatment options for malunions and nonunions of these fractures.