3.1. Surgical Technique

The site of nonunion was exposed using the Henry volar approach, except in three cases in which arthrodesis was performed with a dorsal approach (patient numbers 3 and 8, and the left side of patient number 2). The distal fragment was freshened by removal of fibrous tissues and by bone curettage. A small part of the proximal area was removed to expose normal-appearing bone. We then fixed the nonunion site using a locking T-plate for nonunion fixations and a reconstruction plate for arthrodesis. A segment of the distal ulna was harvested via the antegrade PIBF technique.

In order to harvest the antegrade PIBF, the plane between the extensor carpi ulnaris and the extensor digiti minimi was developed distally. The posterior interosseous artery and its branches to the ulna periosteum were then identified. The desired graft length was chosen, and the vascularized bone flap was cut from the distal ulna. A distal segment of ulna was removed on the posterior interosseous pedicle base to perform the Darrach procedure or the Sauve-Kapandji procedure (7). Depending on the size of the distal fragment and the space gap between the two segments, we used the vascularized bone graft as an onlay bone graft in three nonunions and as an intercalary bone graft in seven. In patient number 3, who had a pathologic fracture and an allograft, radiocarpal joint arthrodesis was performed.