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Bone graft

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Hi all, i broke my arm the first time 17 months ago playing soccer and broke my radius roughly around the middle of the bone which required surgery to place an internal fixation in. The bone healed fine and i was cleared to play soccer again around 14 weeks later but 5 weeks into playing again i fell over, put my arm out and as i fell my opponent also fell on my back which must of put to much pressure on my arm and i suffered a compound fracture and broke both the radius and ulna, the radius broke at the top of the plate on the last screw i think. i was rushed to hospital and went into surgery early the next morning and they placed an internal fixation on both bones, two months later the area where the bone pierced the skin was still not healed and found that i had a infection which required me to be place in hospital for a week. So 12 months on since i broke it for the second time the doctors have told me that my radius has healed fine but my ulna isn't healing and they have tried ultra sound therapy which also hasnt worked.

The next option for me is to have a bone graft taking a bit from my hip and placing it in the area which wont heal. My questions are how long do you have pain for, how long after a bone graft can you start to exercise (because i now coach kids and have to show them how to do drill) and how long till i can play sport again???
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replied June 21st, 2013
Especially eHealthy
hoddo,

Sorry about your injuries.

Essentially, when you have the bone grafting done, it starts the clock over again. So, usually, it takes about 6-8 weeks for a midshaft ulna fracture to heal, so that would still be the expected time for the bone to heal after the grafting. Before a bone graft can be done, the surgeon must be absolutely sure that the infection is totally cleared up. It is bad enough to have an infection OR a nonunion, but it is worse to have an infected nonunion.


So, the usual way to do a bone graft for a nonunion is to "freshen up" the ends of the bone around the nonunion. The fibrous tissue that has formed around the ends of the bone, within the fracture site, all has to be removed. You want to remove this tissue all the way back to raw bleeding bone (remember, bone is living tissue). Then, new internal fixation is applied to the ulnar shaft. Preferably a DCP is used (dynamic compression plate), when will push the ends of the bones together.

Then the surgeon will harvest cancellous bone, usually from the iliac crest (the pelvic brim). The cancellous bone is the "spongy" bone, inside the hard outer cortical bone. It is where the bone marrow is located (where your blood cells are made). So, the surgeon opens a small "trap door" in the hard cortical bone on the top edge of the pelvic brim. Then, using a curette (looks like a tiny ice cream scoop), the surgeon scoops out as much cancellous bone as he/she will need.

This cancellous bone graft will provide both scaffolding for the new bone to grow in on, as well as the cells necessary to "jump start" the healing process (the osteoprogenitor cells).

The surgeon takes this bone graft and packs it in the small gap left after the ends of the bone were freshened up. He/she will pack the graft in this gap and under the plate.

The wound is then closed in layers and the patient is usually placed in a bulky compressive post-op dressing/splint.


This is just like any other orthopedic surgery. Many patients state that the incision on the "hip" area is more tender than the nonunion site. This is probably because the patient sort of knows what to expect, in terms of discomfort at the fracture site. But, the bone graft harvest site is a new one. Also, since the trunk muscles attach to the pelvic brim, anytime the patient is upright or is moving, it can pull on the bone graft site. So, it can be quite tender.



Once the bone is healed, then you can start doing your rehab program. As you know, since you have rehabbed once before, it is going to take some time to regain your motion and strength. Also, you may want to protect your forearm with a light OrthoPlast splint when you return to coaching. Your surgeon or physical therapist can make a custom OrthoPlast splint for you (this is a moldable plastic used to make orthopedic splints).

While you were quite unlucky to have the second fracture, and it should not happen again, you may not want to tempt fate. Especially after all you will have been through to get the bone to unite.


Wishing you the best. Good luck.
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