The patient was taken to the operating room and given a general anesthetic. The entire upper extremity was prepped in a sterile fashion. Antibiotics were administered. The limb was elevated and the tourniquet was inflated.
The previous incision was used. There was extensive scarring found. Proximal extension of the approach was required to accommodate a longer plate. The superficial radial nerve and radial artery were identified proximally and traced distally as the exposure continued. The plate and bone defect were identified. Multiple small bone fragments were found and removed. The bone defect was debrided until the proximal and distal ends of the bone were clear of all scar. Care was taken to protect soft tissue attachments to the bone. Cultures of local tissue were obtained.
The proximal fragment was shaped with a saw to accommodate a step cut graft. The distal fragment was shaped to accommodate a transverse cut graft. This was done to create a stable proximal fragment-allograft interface with maximum surface area contact. The distal fragment-allograft interface was transverse so that rotational alignment of the radius could be fined tuned if needed. Exact measurements were made after verification of the position of the distal radial ulnar joint. A fresh frozen fibula allograft was then cut with a saw to match the defect exactly. The plate was now removed.
Cancellous bone/callous obtained locally was packed into the osteotomies. The allograft was placed into the defect and a pre-contoured 3.5 mm DC plate was place onto the bone and held with clamps. A lag screw was placed across the step cut interface. Eccentric screw placement provided compression across both the proximal and distal fragment-graft interfaces (Figure 3 & Figure 4). A stable construct with normal forearm rotations was achieved. The wound was irrigated and closed over a drain. A long arm bulky compression splint was applied.