Introduction: The bone defects in the long bones are traumatic as a consequence of open fractures or resections due to infection or necrotic nonunion. A devitalised bone with no nutrition or vascularity is liable to an infection, with extension proportional to the size of the necrotic bone. To be sure to eliminate the infection and the nonunion it is necessary to perform open surgery and remove the necrotic and infected segments thoroughly, and then proceed to osteosynthesis and internal transport after osteotomy.

Material and Methods: From 1981 to 2002 203 cases were treated with the Ilizarov Method. The previous treatment given before the patients came to our center was as follows: 1) in tibial nonunion intramedullary nail 17%; 2) in femoral nonunion plates 46%, monoaxial external fixator 42%, intramedullary nail 10%, circular external fixator 4%; 3) humerus nonunion Ender 3%, plates 81%, intramedullary nail 16%; 4) forearm nonunion plates 80%, wires and cast 20%. Our treatment was resection of the infected bone segment and then bifocal internal transport in 162 patients, threefocal convergent transport in 41, or threefocal tandem transport. If the resection does not exceed 4–5 cm. it is possible to perform immediate shortening, first by placing the resection stumps in contact and compression, and then by performing bifocal transport. The bifocal method consists of resection and proximal or distal metaphyseal osteotomy and then internal transport of the free bone segment bringing it into contact with the stump where the resection was performed. In the threefocal convergent method, after resection, two osteotomies are performed, one proximal and the other one distal, and the two bone segments are made to converge on the resection site. In the threefocal tandem method, after resection on a clear-cut proximal or distal infection, the osteotomies are performed on the same bone segment with double level transport. The good result is conditioned by satisfying regeneration in the site of the osteotomies. The rhythm of transport is purely individual and proportional to the patient’s age, and ranges from 1 to ¼ mm a day. In case of hypotrophy of the regenerated bone, concertina manoeuvring becomes necessary, that is shortening and subsequent distraction of the transport segments.

Results: According to these techniques we attained both consolidation and elimination of the infection in 181 cases, that is 89%.

Conclusions: In infectious nonunion healing cannot be possibly achieved through antibiotic therapy, so the only resolving action is the eradication of the necrotic-septic site and then its resection. The consequent limb shortening is compensated, in the Ilizarov Method, by internal transport of the healthy bone segment. Our results are good for cases, and the infection is eliminated in any case.

Purpose: Severe open fractures of the forearm, particularly with bone loss, are particularly difficult to treat. Internal fixation is dangerous and cannot achieve restituitio ad inte-grum. The purpose of our clinical study was to present the method we use that has provided satisfactory results.

Material and method. Over an 18-year period starting in 1981, we have used external fixation of forearm fractures for only five cases, all men, aged 23–65 years. Three were work accident victims, one was a traffic accident victim and the last was an explosion victim. During this same period a total of 181 forearm fractures treated surgically in our unit with the AO method. The five men were treated in an emergency setting within three hours after the accident. The procedure included: 1) debridement to remove damaged soft tissue and minute bone fragments; 2) reduction with a 1.8 endomedullary Kirschner pin (bridging the bone loss); 3) application of a three-ring external fixation plus a 5/8 ring at the elbow to allow complete elbow fixation; 4) proximal osteotomy of the ulna and distal osteotomy of the radius for internal lengthening (0.5 mm per day) designed to achieve bone regeneration known to be slow in the forearm.

Results: In four out of five cases, we obtained bone reconstruction and bone healing within a delay of 176 to 248 days. In one patient, after 125 days, and after filling the bone loss, we converted to internal fixation with a plate and bone grafts to achieve cure 159 days later.

Discussion: Our experience is limited but does include very severe cases where septic complications were avoided and bone loss of 5 to 8 cm was resolved. Internal fixation with intermediary bone grafts would be imprudent in our opinion due to the risk of complication. The shorter limb on which we apply the Ilizarov device favours cure of the soft tissue damage.

Conclusion: The severe open fractures of the forearm, especially in cases with bone loos, can be resolved with external fixation using the Ilizarov method, avoiding the serious complications of necrosis and infection often encountered in these cases.