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Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing.

Kim SB, Heo YM, Yi JW, Lee JB, Lim BG - Clin Orthop Surg (2015)

Bottom Line: Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two.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.The functional results and the average union time were superior in group A than in group B.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Case 3. (A) A 50-year-old man with distal one-third fractures of the left forearm bones. The ulna had an open and severely comminuted fracture. (B) The radius was stabilized by plating. The ulna was treated with excision of the contaminated bony fragment and debridement of the open wound, but it was not fixed. (C) Fracture of the ulnar shaft was treated using a plate and an auto-iliac bone graft and fracture of the ulnar styloid process was treated using tension band wiring after 4 weeks. (D) Union of fractures of the radius and ulna was confirmed at postoperative 26 weeks and 12 weeks, respectively. (E) The implant was removed at postoperative 18 months. No complication was noted until 6 months after removal of the implant.
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Figure 3: Case 3. (A) A 50-year-old man with distal one-third fractures of the left forearm bones. The ulna had an open and severely comminuted fracture. (B) The radius was stabilized by plating. The ulna was treated with excision of the contaminated bony fragment and debridement of the open wound, but it was not fixed. (C) Fracture of the ulnar shaft was treated using a plate and an auto-iliac bone graft and fracture of the ulnar styloid process was treated using tension band wiring after 4 weeks. (D) Union of fractures of the radius and ulna was confirmed at postoperative 26 weeks and 12 weeks, respectively. (E) The implant was removed at postoperative 18 months. No complication was noted until 6 months after removal of the implant.

Mentions: The procedure was performed by one surgeon under general anesthesia or brachial plexus block. A tourniquet was used in all fractures. Fractures were fixed with plating (DCP) or IM nailing (Intramedullary Forearm Rod, Acumed, Hillsboro, TX, USA), which were selected intraoperatively according to the associated soft tissue injuries, swelling, location or pattern of fractures, and patient's condition. All 16 open fractures were initially treated with debridement and irrigation within 24 hours. Six out of the 16 open fractures were treated with internal fixation of both forearm bones at the same time. However, 10 open fractures (6 in group A and 4 in group B) needed a secondary operation to achieve stabilization after an average of 14 days (range, 7 to 28 days). Two fractures, which had a segmental bone defect caused by open injuries, were treated with plating and iliac bone grafting after 27 and 28 days, respectively (Fig. 3). Mostly, open wounds were repaired with primary or delayed closure, except in 2 patients who needed a split-thickness skin graft.


Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing.

Kim SB, Heo YM, Yi JW, Lee JB, Lim BG - Clin Orthop Surg (2015)

Case 3. (A) A 50-year-old man with distal one-third fractures of the left forearm bones. The ulna had an open and severely comminuted fracture. (B) The radius was stabilized by plating. The ulna was treated with excision of the contaminated bony fragment and debridement of the open wound, but it was not fixed. (C) Fracture of the ulnar shaft was treated using a plate and an auto-iliac bone graft and fracture of the ulnar styloid process was treated using tension band wiring after 4 weeks. (D) Union of fractures of the radius and ulna was confirmed at postoperative 26 weeks and 12 weeks, respectively. (E) The implant was removed at postoperative 18 months. No complication was noted until 6 months after removal of the implant.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553274&req=5

Figure 3: Case 3. (A) A 50-year-old man with distal one-third fractures of the left forearm bones. The ulna had an open and severely comminuted fracture. (B) The radius was stabilized by plating. The ulna was treated with excision of the contaminated bony fragment and debridement of the open wound, but it was not fixed. (C) Fracture of the ulnar shaft was treated using a plate and an auto-iliac bone graft and fracture of the ulnar styloid process was treated using tension band wiring after 4 weeks. (D) Union of fractures of the radius and ulna was confirmed at postoperative 26 weeks and 12 weeks, respectively. (E) The implant was removed at postoperative 18 months. No complication was noted until 6 months after removal of the implant.
Mentions: The procedure was performed by one surgeon under general anesthesia or brachial plexus block. A tourniquet was used in all fractures. Fractures were fixed with plating (DCP) or IM nailing (Intramedullary Forearm Rod, Acumed, Hillsboro, TX, USA), which were selected intraoperatively according to the associated soft tissue injuries, swelling, location or pattern of fractures, and patient's condition. All 16 open fractures were initially treated with debridement and irrigation within 24 hours. Six out of the 16 open fractures were treated with internal fixation of both forearm bones at the same time. However, 10 open fractures (6 in group A and 4 in group B) needed a secondary operation to achieve stabilization after an average of 14 days (range, 7 to 28 days). Two fractures, which had a segmental bone defect caused by open injuries, were treated with plating and iliac bone grafting after 27 and 28 days, respectively (Fig. 3). Mostly, open wounds were repaired with primary or delayed closure, except in 2 patients who needed a split-thickness skin graft.

Bottom Line: Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two.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.The functional results and the average union time were superior in group A than in group B.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus