Successful Management of Midshaft Ulna Non-union Using Vascularized Fibula Grafting Following Failed Internal Fixation: A Case Report.

INTRODUCTION: Atrophic non-union of forearm fractures following repeated failed fixation remains a difficult problem in orthopedic surgery because of compromised biology and mechanical instability. Vascularized fibular grafting offers structural support along with enhanced osteogenic potential in resistant cases. CASE REPORT: A 45-year-old male presented with painful atrophic non-union of the midshaft ulna following failed intramedullary Kirschner wire fixation and subsequent failed revision plating with cancellous bone grafting. Persistent pain, instability, and functional limitation necessitated further intervention. Revision open reduction and internal fixation combined with vascularized fibular grafting was performed. Serial follow-up radiographs demonstrated progressive graft incorporation and fracture healing. Complete radiological union with satisfactory functional recovery was achieved at 1-year follow-up. CONCLUSION: Vascularized fibular grafting is an effective salvage procedure for resistant ulna non-union after failed fixation, providing reliable biological augmentation and structural stability in complex cases.