Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing.
BACKGROUND
Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs.


METHODS
Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.


RESULTS
In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent.


CONCLUSIONS
The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
Sang Bum
SB
Kim
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
Youn Moo
YM
Heo
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
Jin Woong
JW
Yi
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
Jung Bum
JB
Lee
Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.
Byoung Gu
BG
Lim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000706:statistics & numerical data*; D001860:Bone Plates / Q000706:statistics & numerical data*; D005260:Female; D005542:Forearm / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000453:epidemiology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
Diaphyses; Forearm; Fracture; Internal fixation