The use of iliac crest strut graft for forearm nonunion gaps in 10 patients: Nicoll’s technique revisited

Abstract

Objectives: We evaluated the results of surgical treatment of established forearm nonunion gaps with the use of a corticocancellous graft block from the iliac crest (Nicoll’s technique) secured with a plate and screws.
Patients and methods: The study included 10 patients (5 men, 5 women; mean age 39 years; range 25 to 60 years). Six patients had ulnar, three patients had radial nonunion gaps; both bones were affected in one patient. Five patients had open fractures and six patients had active infections. The patients were treated after a mean elapse of 19.6 months (range 10 to 36 months) from injury. The length of the bone gaps ranged from 2.5 cm to 5.0 cm (mean 4.1 cm). Stabilization was performed with a 3.5 mm AO dynamic compression plate and one or two screws. In one patient who had involvement of both bones, intramedullary nailing was used. Functional results were evaluated according to the scoring system of Anderson et al. The mean follow-up period was 28 months (range 20 to 43 months).
Results: Union occurred in all the patients in a mean of 4.65 months (range 4 to 6 months). Healing was uneventful in nine patients. One patient developed a superficial infection. All the patients regained full extension and flexion of the elbow. In one patient, distal radioulnar subluxation persisted in the postoperative period. Time to union was significantly prolonged in patients with a greater bone gap (p=0.004) and with a longer delay from the occurrence of injury (p=0.02); however, none of these had a significant effect on final functional outcomes (p>0.05).
Conclusion: The use of a corticocancellous bone block from the iliac crest is a simple and reliable procedure in the management of nonunion gaps of the forearm.