Management of post-infection forearm defect non-unions following the “Road-to-Union” protocol: technical note and case series

Diaphyseal non-union of forearm fractures that involve both the ulna and radius present unique challenges to treat. If left untreated, these non-unions may lead to severe instability of the forearm and/or chronic pain. Existing treatments include bone grafting, fibular grafts, and the Masquelet technique, however, currently no gold standard treatment exists. The “Road-to-Union” protocol is a two-stage surgical approach originally developed for managing complex tibial bone defects. It integrates debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and structured rehabilitation. This technique addresses challenges such as infection, bone loss, and deformity by providing a systematic pathway to achieve bone healing and restore function. While traditionally used in the lower limb, its application in the forearm has not been widely reported. This case series explores the adaptation of the “Road-to-Union” protocol for forearm reconstruction, aiming to restore structural integrity and function in complex non-union cases.