Diaphyseal fractures of the forearm in adults, comparative study of dynamic compression plate versus intramedullary nail
Keywords:Diaphyseal forearm fractures, Dynamic compression plate, Square nail
Background: Forearm fractures are common nowadays because of road traffic accident. It is important to achieve anatomical reduction of both bone forearm fractures to regain function of upper limb. This study is undertaken to observe functional and radiological outcome using two different surgical modalities like dynamic compression plating (DCP), and intramedullary nailing in both bone forearm fractures and also to indivualize the optimal treatment method for different fracture pattern.
Methods: Our study included 60 patients with diaphyseal forearm fractures in adults presenting to orthopaedic outpatient department. Among 60 patients, 30 patients underwent open reduction and internal fixation by dynamic compression plate and other 30 patients underwent closed reduction/open reduction by square nail after detailed pre-operative evaluation.
Results: In our study average union time in DCP group is 23.39 weeks and square nail group is 28.89 weeks. Union in DCP group was 27 (90%) and square nail group 22 (73.33%). Delayed union in DCP group was 03 (10%) and in Square nail group was 6 (20%), non-union in DCP group was 0 (nil) and in square nail group was 2 (06%).
Conclusions: Open reduction and internal fixation with DCP plates for both bone diaphyseal forearm fractures gives good results with early union rates. We also found that in open fractures and complex fracture like segmental fractures square nailing was better option compared to dynamic compression plate to reduce infection rates, retain periosteal blood supply from soft tissue. Thus we conclude that both implants are equally important and we should prioritize based on preoperative planning.
Russel TA. Campbell’s Operative Orthopaedics. 8th edition. 2nd Volume. Classification of Diaphyseal fractures. 2017: 728-730.
Saikia KC, Bhuyan SK, Bhattacharya TD, Borgohain M, Jitesh P, Ahmed F. Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate. Indian J Orthop. 2011;45(5):417.
Naiman PT, Schein AJ, Siffert RS. Use of ASIF compression plates in selected shaft fractures of the upper extremity. A preliminary report. Clin Orthop. 1970;71:208-16.
Duncan R, Geissler W, Freeland AE, Savoie FH. Immediate internal fixation of open fracture of the diaphysis of the forearm. J Orthop Trauma. 1992;6:25-31.
Reilly TJ. Isolated and combined fractures of the diaphysis of the radius and ulna. Hand Clin. 2002;18:179-94.
Knight RA, Purvis GD. Fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1949;31:755-64.
Moore TM, Klein JP, Patzakis MJ, Harvery JP. Results of compression- plating of Galeazzi fractures. J Bone Joint Surg Am. 1985;67:1015-21.
Evans EM. Rotational deformity in the treatment of fractures of both bones of the forearm. J Bone Joint Surg. 1945;27(3):373-9.
Patrick J. A study of supination and pronation, with especial reference to the treatment of forearm fractures. J Bone Joint Surg Am. 1996;28(4):737-48
Dodge HS, Cady GW. Treatment of fractures of the radius and ulna with compression plates: A retrospective study of one hundred and nineteen fractures in seventy eight patients. J Bone Joint Surg Am. 1972;54:1167-76.
Ross ER, Gourevitch D, Hastings GW, Wynn-Jones CE, Ali S. Retrospective analysis of plate fixation of diaphyseal fractures of the forearm bones. Injury. 1989;20(4):211-4
Chapman MW, Gordon JE, Zissimos AG. Compression plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71(2):159-69.
Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992;74:1068-78.
Anderson LD, Sisk D, Tooms RE, Park WI. Compression plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57:287-97.
Ozkaya U, Kilic A, Ozdogan U, Beng K, Kabukcuoglu Y. Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures. Acta Orthop Traumatol Turc. 2009;43:14-20.
Grace TG, Eversmann WW Jr. Forearm fractures: treatment by rigid fixation with early motion. J Bone Joint Surg Am. 1980;62:433-8.
Stevens CT, ten Duis HJ. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg. 2008;74:180-3.
Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. 1983;175:25-9.
Leung F, Chow SP. A prospective randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures. J Bone Joint Surg Am. 2003;85:2343-8.
Droll KP, Perna P, Potter J, Hamiman E, Schemitsch EH, McKee MD. Outcomes following plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 2007;89:2619-24.
Kose A, Aydin A, Ezirmik N, Can CE, Topal M, Tipi T. Alternative treatment of forearm double fractures: new design intramedullary nail. Arch Orthop Trauma Surg. 2014;134:1387-96.
Lee YH, Lee SK, Cjung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am. 2008;90:1891-8.
Kose A, Aydin A, Ezirmik N, Topal M, Can CE, Yilar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulus Travma Acil Cerrahi Derg. 2016;22:184-91.
Kose A, Aydin A, Ezirmik N, Topal M, Can CE. Treatment of isolated ulnar fractures in adults with a new intramedullary nail. Minerva Orto-pedica e Traumatologica. 2015;66:123-31.