22/ ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL., 81, 2014, p. 22–32 CURRENT CONCEPTS REVIEW SOUBORNý REFERáT BACKGROUND Forearm fracture non-unions are uncommon but com- plex problems that present a signifcant therapeutic cha- llenge. The forearm is a unique anatomical unit with an important relationship between the radius, ulna, interos- seous membrane, elbow and wrist which determines its complex biomechanics and function. Thus, treatment of both acute forearm fractures and non-unions can be dis- tinctly different to that of other long bones. Anatomical restoration of length, alignment, rotation, radio-ulnar ar- ticulation and radial bow are essential for enabling the optimal stabilising effects of forearm muscles and in- terosseous membrane, range of movement, particularly pronation-supination, and overall function with positio- ning of the hand in space (25, 53). Contemporary plate osteosynthesis, specifcally using the dynamic compression plate (DCP) and low contact DCP (LC-DCP) developed by the AO group, combined with established techniques of internal fxation have revolutionised the treatment of diaphyseal forearm fractures. This has minimised failure to heal and rates of non-union whilst achieving good to excellent functio- nal outcomes (8, 10, 22, 43, 46, 53). Forearm fractures treated with plate osteosynthesis demonstrate non-union rates under 5% (8, 10, 22, 46, 53) and a target rate of < 2% is stated if fracture fxation is executed with good technique in the compliant patient (8). Consequently, the published evidence for treatment of this problem is lac- king (16, 26, 32, 41, 46, 57). Non-union of the forearm is also intimately associated with signifcant pain experience, marked pre-operative functional disability and physical and psychosocial mor- bidity (3). This review discusses the current concepts and evidence base, aiming to address the controversies and provide recommendations to guide management of this challenging problem in achieving both optimal cli- nical and patient related functional outcomes. Non-Union in Forearm Fractures Paklouby po zlomeninách předloktí P. JAYAKUMAR, J. B. JUPITER The Hand and Upper Extremity Service. Massachusetts General Hospital and Harvard Medical School. Boston, MA. USA ABSTRACT Non-union in forearm fractures is an uncommon but complex problem. This is especially given the unique anatomical structure and function of the forearm, making treatment distinctly different to that of other long bone fractures. Anatomical restoration of length, alignment, rotation and the radial bow maintains the optimal stabilising effects of the forearm muscles and interosseous membrane, as well as maximising the range of movement, particularly pronation and supination. Contemporary plate osteosynthesis using variations of the dynamic compression plate (DCP) developed by the AO group combined with established techniques of internal fxation have revolutionised the treatment of diaphyseal forearm fractures. Non-union rates have been minimised to below 5% and good to excellent functional outcomes are achieved. Non-union of the forearm is also intimately associated with a signifcant pain experience, marked pre-operative functional disability and physical and psychosocial morbidity. This review examines the literature and presents a guide to manage- ment as well as the current controversies and future directions related to this challenging problem.