Forearm fracture nonunion is relatively uncommon but can present a unique challenge for patients and surgeons alike [1]. These conditions can be severely disabling for patients and often require operative intervention [1]. Patients with forearm nonunion are known to demonstrate poor health-related quality of life metrics [2,3]. One study demonstrated that forearm nonunion resulted in a significantly greater health-related quality of life reduction than nonunion of the humerus, femur, or tibia [2]. The health-related quality of life metric scores in patients with forearm nonunion are worse than those reported for stroke, type-1 diabetes mellitus, and acquired immunodeficiency syndrome [2].

Forearm nonunion can be associated with infection and/or a poor surrounding soft tissue environment for healing [3]. Therefore, addressing the mechanical stability and biologic environment at the fracture site is paramount to ensure adequate fracture healing [1,3]. Forearm nonunion can be addressed with corrective reconstruction, with or without the use of various bone graft materials [1,3]. Autograft bone remains a useful adjunct by providing osteogenic properties [4]. Iliac crest bone graft (ICBG) has historically been considered the gold standard, but there are concerns with donor-site morbidity [4]. Other options include femoral autograft from reamer/irrigator/aspirator (RIA) [5], tibial metaphysis cancellous autograft [3], or local autograft, such as from the distal radius or olecranon [6]. Other non-autologous graft materials have been described previously, including allografts [7] and synthetics, like hydroxyapatite [8] or recombinant human bone morphogenetic protein products [9]. Despite the multitude of graft options available, there is uncertainty regarding the optimal graft choice, or even when graft is necessary at all.

Prior studies have investigated outcomes after forearm nonunion or malunion repair with or without different bone graft materials [6,[10], [11], [12], [13], [14]]. However, many of these studies have involved case series or small cohorts, which are at risk of being underpowered, particularly when identifying differences in complication rates between groups. There is currently a lack of adequately powered studies investigating short-term complications and healthcare utilization after forearm nonunion or malunion reconstruction with or without the use autograft. The purpose of this study is to compare short-term outcomes and healthcare utilization metrics after forearm nonunion or malunion repair with or without the use of autograft.