A 27-year-old man with an eight-month history of delayed fracture healing and hardware loosening following forearm surgery was successfully managed using a Qi-regulating and bone-reconnecting herbal strategy combined with traditional cedar bark splinting.

Case ID: CHC-0071

Case Summary

This case describes a 27-year-old man who experienced delayed healing of left forearm fractures eight months after undergoing open reduction and internal fixation (ORIF) surgery. Presenting with hardware loosening, widened fracture gaps, and the formation of a pseudarthrosis (false joint), he refused a second surgery. The original report documented a conventional diagnosis of delayed healing of ulnar and radial fractures with distal radioulnar joint dislocation, and a TCM assessment of Bone Wilting (Gu Wei) driven by Blood Stasis and Qi Stagnation. He was managed through a highly integrative approach combining traditional cedar bark splint fixation over his loose hardware, targeted axial tapping rehabilitation, localized acupoint injections, and an internal Tongluo Xuduan Fang (Collateral-Unblocking and Bone-Reconnecting Formula) to resolve the stasis and regenerate the bone.

Patient Presentation

• Patient: 27-year-old male (Surname: Ding).
• Main Complaint: Left forearm swelling, pain, and restricted movement resulting from delayed fracture healing.
• History: The patient sought consultation following an eight-month ordeal. On October 10, 2014, he fell during exercise, sustaining comminuted fractures of the left mid-lower radius and ulna, along with a distal radioulnar joint dislocation. He underwent emergency ORIF surgery with steel plates and screws. Six months post-surgery, he experienced mild discomfort. By the eighth month, symptoms worsened significantly with pain upon movement, abnormal mobility at the fracture site, and local tenderness. He also reported a depressed mood, poor sleep, a bitter taste in his mouth, and poor appetite.

Examination and Diagnosis

• Physical Exam: The internal fixation on the injured limb was loose, displaying abnormal pseudarthrosis (false joint) movement in the mid-ulna and radius. Local blood supply was poor, accompanied by left forearm edema and localized tenderness.
• Imaging (DR): Revealed loosening of the ulnar and radial steel plates, no obvious callus growth, widened fracture gaps, partial bone absorption, and internal fixation failure.
• Conventional Diagnosis: 1. Delayed healing of left ulnar and radial fractures; 2. Left distal radioulnar joint dislocation.
• TCM Tongue and Pulse: The tongue body was dark purple with stasis spots (瘀斑) and short, thick sublingual veins. The coating was yellow and thick. The pulse was sunken and slippery (脉沉滑).

TCM Assessment

The original practitioner interpreted the presentation as Bone Wilting driven by Blood Stasis and Qi Stagnation (骨痿 – 血瘀气滞).

According to the holistic principles of yin and yang Chinese Medicine the severe initial trauma combined with extensive periosteal stripping during the lengthy surgery severely damaged the local micro-circulation. When the internal fixation failed and loosened, chronic localized blood stasis formed. Because the stagnant blood blocked the collaterals, fresh nutrients could not reach the fracture site, preventing new bone from growing (delayed healing) and causing the sinews and bones to “wilt.” The dark purple tongue with stasis spots and short, thick sublingual veins provided objective textbook confirmation of this deep, chronic blood stasis.

Treatment Approach

The primary treatment principle was to regulate Qi and dispel stasis, benefit essence and reconnect the broken bones (理气祛瘀，益精续断). The strategy required a multi-pronged approach: manually stabilizing the loose fracture using traditional external splinting without immediately subjecting the patient to another traumatic surgery, while heavily using herbs and injections to flood the “starved” bone with fresh blood and Kidney essence.

Interventions and Herbal Formulas

• External Fixation and Manipulation: The practitioner applied “Zhao’s balanced bone-setting reduction” using bone-separating pads and a traditional cedar bark small splint (杉树皮小夹板) to externally stabilize the arm over the loose internal hardware.
• Acupuncture & Acupoint Injection: Acupuncture was applied to Dazhu (BL11), Shenshu (BL23), Zusanli (ST36), Yanglingquan (GB34), Taixi (KI3), and Juegu (GB39). Cervus and Cucumis polypeptide and bone-strengthening liquid were injected locally at the fracture ends and Ahshi points.
• Rehabilitation (Axial Tapping): The patient was instructed to perform axial tapping on the radius and ulna 5-10 times daily (30-50 taps per session) to provide biomechanical stress stimulation, which guides callus formation.
• Internal Herbal Formula: A 14-herb decoction acting as a modified Tongluo Xuduan Fang (Collateral-Unblocking and Bone-Reconnecting Formula).
  • Moving Blood and Unblocking Collaterals: Dang Gui (10g), Chuan Xiong (15g), Gui Zhi (25g), Qiang Huo (15g), Hong Hua (10g), Tao Ren (6g), and Shen Jin Cao (30g) aggressively break up the old stasis, promote new blood generation, and unblock the meridians.
  • Reconnecting Bone and Benefiting Kidneys: Xu Duan (20g), Gu Sui Bu (15g), Zi Ran Tong (Pyrite, 30g), Gou Qi (20g), and Sang Ji Sheng (20g) directly target the Kidneys and bones to stimulate intense callus growth and weld the fracture.
  • Boosting Qi and Spleen: Huang Qi (20g), Bai Zhu (15g), and Fu Ling (15g) boost Qi (the commander of blood) and strengthen the Spleen. Zhi Ke (10g) and Yu Jin (10g) regulate Qi and relieve depression. Gan Cao (10g) harmonizes.
  • Administration: 14 doses prescribed, taken warm twice daily. Alternated with Gejie Dabu Wan (Gecko Great Tonifying Pill) to strongly rebuild essence.

Follow-Up

• Three Months Later: A follow-up showed a small amount of callus formation, and the abnormal pseudarthrosis movement had disappeared. The same treatment protocol was continued for another three months.
• One Year Post-Treatment (December 2015): The fracture line had basically disappeared. The patient underwent surgery to remove the old, loose internal fixation plates. The arm was again immobilized with a cedar bark splint for one month during recovery.
• Outcome (January 2016): X-rays confirmed the fracture line was completely gone. There was no local tenderness, and wrist and arm function had recovered well, achieving a complete clinical cure.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the successful rescue of a non-union/delayed union fracture without requiring a second invasive bone-grafting surgery.

When surgical plates loosen and a false joint forms, conventional orthopedics almost universally mandates immediate re-operation. However, Professor Zhao recognized that the patient’s local periosteum was already severely stripped and traumatized from the first surgery; another surgery might fail again due to poor blood supply. Brilliantly, he chose to leave the loose plates inside temporarily and applied a flexible traditional cedar bark splint on the outside to correct the deformity and provide dynamic stability. By combining this with targeted axial tapping (employing Wolff’s Law, where mechanical stress stimulates bone growth) and aggressive blood-moving/bone-knitting herbs (Zi Ran Tong, Gu Sui Bu, Xu Duan), the treatment successfully revitalized the “dead” fracture ends, proving the immense value of TCM conservative orthopedics in complex post-surgical complications.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：中医治疗骨折延迟愈合案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 22, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation