[Revision surgery in diaphyseal forearm fractures].
OBJECTIVE
The aim of the study was to compare the results of revision surgery in diaphyseal fractures of the ulna and radius treated by intra-medullary interlocking nailing or plate osteosynthesis.


METHODS
The group included 36 patients who, in the period from 2000 to 2005, were treated with the use of the intra-medullary ForeSight nail system (Smith & Nephew, USA) or a small, 3.5 mm auto-compression plate (different manufacturers). Pseudoarthrosis developed in 25 patients and recurrent fractures were found in 11 patients (six of these suffered fractures along the original fracture line after minimal trauma and five showed a recurrent fracture at the site of screw tunnels). The average age of the patients was 37.3 years. The average period between injury and revision surgery was 16 months (range, 4 to 32 months). The follow-up included examination for early and late complications and the evaluation of X-ray findings and functional outcomes.


RESULTS
The average follow-up was 21 months (range, 12 to 36 months). For revision surgery, an intra-medullary nail was used in 28 and a plate in 8 patients. The average operative time was 85 min (range, 30 to 180 min). Radiographic union was achieved by 6 months in 30, by 12 months in three and by 18 months in three patients. The average fusion time in the 30 patients healing by 6 months (nailing, 23x, 7x plate osteosynthesis) was 16.05 weeks. The range of motion in the wrist, forearm and elbow was evaluated by the Anderson method. The outcomes were excellent, good and satisfactory in 11, 15 and 10 patients, respectively. Poor results or wrist or elbow stiffness were not recorded. Pain was recorded at rest and in activity, taking requirements for analgesic therapy into account. After revision surgery, 22 patients were free from pain, 10 reported occasional pain during activity and four experienced pain at rest. None of the patients required permanent analgesic therapy.


CONCLUSIONS
The results of our study show the effectiveness of plate and nailing techniques in revision forearm surgery. The corrective procedure must be chosen with regard to the type of pseudoarthrosis, and individual therapy respecting the principles of stable osteosynthesis is necessary. A differentiated operative approach, infection control and stimulation of bony union also play important roles.
Visna
P
P
Traumatologické oddelení, Ortopedická klinika 1. LF UK a FN Motol, Praha. petr.visna@fnmotol.cz
Beitl
E
E
Smídl
Z
Z
Kalvach
J
J
Jaganjac
E
E
D000328:Adult; D000368:Aged; D018483:Diaphyses; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000601:surgery*; D012086:Reoperation; D014458:Ulna Fractures / Q000601:surgery*