Selective screw placement in forearm compression plating: results of 75 consecutive fractures stabilized with 4 cortices of screw fixation on either side of the fracture.
OBJECTIVE
To (1) assess the effectiveness of an alternative plate and screw construct for all diaphyseal forearm fracture patterns and (2) test the hypothesis that as the working length (WL) to plate length (PL) ratio increases, so does the construct instability and therefore likelihood of failure.


METHODS
Retrospective.


METHODS
Level 1 trauma center.


METHODS
Sixty-three patients were operatively treated and 53 were available for follow-up, totaling 75 diaphyseal fractures (19 ulna, 12 radius, and 22 radius/ulna). Average follow-up was 14.6 months (8-26).


METHODS
Patients were followed postoperatively at 1 to 2 weeks, 6 weeks, 10 weeks, 4 months, and then at 3 month intervals. Radiographs were analyzed for changes in fracture alignment, loose or broken hardware, and fracture-healing characteristics. Fracture union was defined when a fracture was radiographically healed and clinically asymptomatic, and the patient was able to return to all activities without restrictions.


RESULTS
No fractures showed radiographic evidence of changes in alignment after fixation. There were no refractures, no infections, and one nonunion. The overall union rate after the index procedure was 97.1% for the radius and 97.6% for the ulna. WL:PL ratio averaged 0.17 (range 0-0.57) and the most frequently used PL was 7 holes (n=43). Patients with closed fractures did have a significantly reduced time to union when compared to those with open fractures (P=0.002). Overall union rate averaged 9.8 weeks (range 6-32 weeks).


CONCLUSIONS
Fixation with a standard length compression plate and four cortices of screw fixation on either side of the fracture seems to be a stable construct for diaphyseal forearm fractures and may result in union rates equivalent to those cited in the literature.
Lindvall
Eric M
EM
Florida Orthopaedic Institute, 4 Columbia Drive, Suite 710, Tampa, FL 33606, USA. elindvall@floridaortho.com
Sagi
Henry C
HC
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005543:Forearm Injuries; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000601:surgery*