Introduction: Non-union of the distal radius is an infrequent entity. Recently, it has been identified more often and it has been speculated that external fixation and other techniques used to maintain radial length, may create defects that favor the non-union. In chronic injuries, residual deformity and retraction of tissues are difficulties for treatment.
Case presentation: We report the case of a 40-year-old male patient with a nonunion after a Frykman VIII distal radius fracture managed unsuccessfully with external fixation with a Green-type cast, and with one year of evolution showing a serious <<Z deformity. The patient underwent a first surgical procedure with external fixation to achieve distraction for 30 days, then a second event with intramedullar nailing and autografting with 3 cm of iliac crest and finally a Sauvé-Kapandji procedure. We achieved consolidation of the lesion with graft integration. Satisfactory range of motion, including pronation and supination, were recovered.
Discussion: The combination of these three surgical events allows joint rescue, in spite of the deformity and time of evolution. A first procedure based on ligamentotaxis allowed for gradual recovery of the joint relationships and prepared the area of bone loss to be restituted. On the second procedure it is possible to use an implant on the distal remain with enough osteogenic supply, and finally the third procedure will restore pronation and supination, usually lost during injuries in that area.