Limb Salvage of a Massive Distal Radius and Ulna Osteoarticular Defect Using Acute Bone Shortening.

CASE: A 53-year-old man sustained a severe open distal radius and ulna fracture with approximately 7-cm osteoarticular bone loss, extensive extensor musculotendinous junction avulsions, and radial nerve disruption. Acute 3-cm forearm shortening restored tendon tension and reduced defect size, enabling primary tendon reconstruction with pull-in sutures and nerve repair. Early staged free vascularized fibular grafting was performed. Despite postoperative Pseudomonas aeruginosa infection requiring implant removal and local antibiotics, solid union was achieved with preserved forearm rotation at 2 years. CONCLUSION: Acute bone shortening facilitates simultaneous tendon reconstruction and defect reduction, expanding limb-salvage options in complex distal forearm osteoarticular injuries.