Figure 2 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
A-D. Preoperative posterior-anterior and lateral radiographs of a 49-year-old male with right diaphyseal forearm fracture (A, B); postoperative posterior-anterior and lateral radiographs of 12 months (C, D).
Source publication
Objective:
This study aimed to compare functional and radiographical outcomes following intramedullary nailing (IMN) versus plate and screw osteosynthesis in managing patients with diaphyseal forearm fractures.
Methods:
Forty-six patients (27 male, 19 female) were included in this retrospective study. Of these, 25 were treated with plate osteosy...
Context in source publication
Similar publications
Background
Forearm and olecranon fractures are a common orthopaedic injury. This study aimed to analyse whether the incidence of forearm injury is changing and identifying trends in the number of forearm and olecranon fractures using public aggregated data in Sweden.
Methods
The number of forearm and olecranon fractures as defined by the number of...
Background
Distal radial fractures are common forearm injuries. A key rehabilitation objective is achieving adequate wrist palmar and dorsal flexion range-of-motion (ROM). However, few studies have explored this relationship, with even lesser number of studies investigating the impact of distal radius alignment on wrist ROM limitation due to fractu...
Hand and forearm trauma is a significant public health concern that has notable physical, psychological, and socioeconomic implications. Understanding the variations in occurrence and characteristics of injuries across different regions is crucial for effective implementation of preventive measures, management strategies, and resource allocation. T...
Pediatric bone injuries are traditionally diagnosed using radiography. However, ultrasonography is emerging as an alternative due to its speed and minimal invasiveness. This study assessed the diagnostic capabilities of ultrasound before radiography in a group of 186 children with suspected long bone fractures at Saint Etienne University Hospital (...
Monteggia fracture-dislocation is an inherently unstable injury in the elbow region, characterized by a fracture of the proximal ulna associated with dislocation of the radial head, often with high rates of postoperative complications. Some variants of this injury involve a combination with a fracture of the radial head, which further complicates t...
Citations
... BBFFs in adults carry a significant risk of AEs. Most publications report incidences between 20% and 40% depending on the inclusion criteria 2,6, [16][17][18] . However, there is considerable inconsistency in AE incidences as the highest reported incidence is 45% 3 , whereas the lowest is 5% 19 . ...
... F ifteen studies met the set inclusion criteria. Among the studies, there were 3 randomized clinical trials and 12 retrospective case series (one with a prospective follow-up) 2,3, [9][10][11][12][16][17][18][19][26][27][28][29][30] . Overall, the studies yielded 944 BBFF patients with a mean age of 38 years (range 12-85). ...
... Second, in some studies, there might be underreporting of minor AEs, such as superficial infections, delayed union, and transient nerve injuries. Although underreporting is difficult to showcase, for example, nerve injuries were mentioned in only 10 of the 15 studies included 2,3,9,11,[16][17][18]27,28,31 . Third, the fracture characteristics and associated injuries were different. ...
Background
Both-bone forearm shaft fractures (BBFFs) in adults carry a significant risk of adverse events (AEs). Based on the current literature, there is considerable variance in AE incidence reporting. We aimed to systematically review the literature on BBFFs in adults treated with compression plate fixation, assessing AEs and long-term outcomes.
Methods
We performed a systematic review based on the PubMed database on the current literature on adult BBFFs treated with open reduction and internal fixation with compression plates. Two authors independently collected the data, and a third author resolved disagreements between the 2 reviewers. The primary outcome measure was postoperative AEs, whereas the secondary outcome was to review the long-term outcomes. We evaluated the methodological quality of the studies with a modified version of the Coleman Methodology Score.
Results
Fifteen studies (12 retrospective case series and 3 randomized controlled trials) met the set inclusion criteria. In total, there were 944 patients, of whom 24% (n = 224) experienced some AEs, and 14% had major AEs requiring secondary operations or remaining persistent. The most common AEs were postoperative nerve injuries (incidence 7%, n = 64/944) and fracture nonunion (incidence 5%, n = 45/944). Disabilities of the Arm, Shoulder, and Hand scores were available for 135 patients (5 studies), with a mean score of 12.5 (range 0-61). According to the modified Coleman Methodology Scores, there were 2 good-, 1 fair-, and 12 poor-quality studies among the included studies.
Conclusion
BBFF compression plate fixation in adults poses a relatively high AE risk (24%). According to available patient-reported outcomes and range of motion measurements, the average postoperative outcomes are good, although a minor disability typically persists to some extent. There is a need for high-quality prospective trials assessing the treatment and outcomes of BBFFs in adults to improve forearm fracture treatment.
Level of Evidence
Level III . See Instructions for Authors for a complete description of levels of evidence.
... Abstract screening excluded 376 records, leaving 37 studies for full-text review. Twentyeight further studies were excluded, leaving nine studies to be included in the meta-analysis ( Fig. 1) [9,[22][23][24][25][26][27][28][29]. ...
... Two randomized controlled trials (RCTs) and seven cohort studies met the inclusion criteria (Table 1) [9,[22][23][24][25][26][27][28][29]. There were 471 patients; 238 cases underwent IMN (51%), and 233 underwent ORIF (49%). ...
... Overall, both-bone forearm fractures (BBFF) and AO/ OTA type A fractures were the most commonly reported fracture types and classifications (Table 2) [9,[22][23][24][27][28][29]. ...
Background
Diaphyseal radius and ulna fractures require surgical fixation in adults. Open reduction and internal fixation (ORIF) have been considered the gold standard of treatment. The recent development of an interlocking intramedullary nail (IMN) has provided an alternative treatment method for these fractures. The objective of this meta-analysis is to compare the outcomes and complications of IMN versus ORIF for diaphyseal forearm fractures in adults.
Methods
MEDLINE and Embase were searched from January 1, 2000, through January 7, 2024. All English-language studies were included comparing radiographic and functional outcomes for interlocking IMN fixation and ORIF of diaphyseal forearm fractures in adults (age ≥ 18 years). Study demographics, fracture data, functional outcomes, radiographic outcomes, and complications were extracted. Study quality was determined using the ROBINS-I criteria for cohort studies and the Cochrane risk of bias 2.0 (RoB 2) tool for randomized controlled trials. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Data was analyzed using subgroups of all diaphyseal fractures (including isolated radius or ulna fractures) and those with BBFFs.
Results
Nine studies were included for analysis. There were 42 isolated radius, 80 isolated ulna, and 116 both-bone fractures (BBFF) treated with IMN and 36 radius, 81 ulna, and 116 both-bone fractures treated with ORIF. Compared to ORIF, IMN of diaphyseal forearm fractures appeared to be associated with shorter operative times and a lower overall complication rate. Time-to-union and the rate of nonunion following IMN were similar to ORIF. According to the Grace–Eversmann score, functional outcomes tended to be better following IMN, but DASH scores were similar between fixation strategies.
Conclusions
Our findings suggest that interlocking IMN can be a safe and effective treatment option for simple and complex diaphyseal forearm fractures in adults. Further high-quality studies are needed to define indications for treating diaphyseal fractures with an interlocking IMN.
Level of Evidence
Therapeutic Level IV.
... IM nail techniques minimize damage to soft tissue and the periosteum and promote secondary callus formation, providing a better alternative. The recently developed interlocking IM nailing method prevents not only rotational stability of the fracture, but also bone shortening [8,9,14,15]. Some researchers have suggested that comminuted fractures, segmental fractures, and fractures near the diaphyseal-metaphyseal junction are appropriate indications for interlocking IM nailing in forearm fractures [3,5,7,16]. ...
... However, in our study, IM nailing alone resulted in a higher incidence of non-union and changes in bone length. Polat et al. [14] compared two groups who were treated with IM nails and plates, finding that distant [4,9,10,14,15,17]. Our results were different from previous results, and are the core of our study implications. ...
... However, in our study, IM nailing alone resulted in a higher incidence of non-union and changes in bone length. Polat et al. [14] compared two groups who were treated with IM nails and plates, finding that distant [4,9,10,14,15,17]. Our results were different from previous results, and are the core of our study implications. ...
Background
Segmental fractures often result from high-energy or indirect trauma that causes bending or torsional forces with axial loading. We evaluated surgical outcomes of patients with forearm segmental diaphyseal fractures.
Methods
We retrospectively analyzed data from patients with forearm segmental fractures for which they underwent surgery at the Pusan National University Trauma Center from March 2013 to March 2022. We also analyzed accompanying injuries, injury severity score (ISS), injury mechanism, occurrence of open fracture, surgical technique, and treatment results.
Results
Fifteen patients were identified, one with bilateral segmental diaphyseal forearm bone fracture, for a total of 16 cases. Nine of the patients were male. The overall mean age was 50 years, and the mean follow-up period was 16.2 months. Six cases who underwent surgery using plate osteosynthesis achieved bone union without length deformity at final follow-up. Three of seven patients who underwent intramedullary nailing alone underwent reoperation due to nonunion. Six cases achieved bone union at final follow-up, three of which showed length deformity. Three patients underwent surgery using a hybrid method of IM nailing, plates, and mini cables. One patient who underwent surgery with a plate and one patient who underwent surgery with IM nailing alone showed nonunion and were lost to follow-up.
Conclusion
Plate osteosynthesis is considered the gold standard for treatment of adult forearm diaphyseal segmental fractures. In this study, IM nailing was associated with high rates of non-union and length deformity. However, the combination of IM nailing and a plate-cable system may be an acceptable alternative in segmental diaphyseal forearm fracture, achieving a union rate similar to that provided by plate fixation.
... In our study, the right side was more common in both groups. Ambhore et al. [2] and Polat et al. [20] studies also had a majority of fractures in the right forearm, which is correlated with our study. In this study, both groups were statistically similar in terms of age, gender, and side of injury. ...
Introduction:
In this era of active living, industrial growth, increasing automobile accidents, and athletic activities, fractures of the forearm bones are becoming more frequent. The incidence of diaphyseal fractures of both bone forearms is reported to be approximately 10 per 10,000 persons per year, although rates may vary according to age and sex. If not properly treated, a fracture of the forearm bones might cause a serious loss of function. Therefore, to restore function, these fractures require adequate anatomical reduction and internal fixation. The majority of forearm fractures in adults are treated surgically, and various modes of internal fixation are available. In this study, we evaluated and compared the clinical, functional, and radiological outcomes of both bone forearm diaphyseal fractures treated with plate osteosynthesis and intramedullary nailing.
Material and method:
This prospective and comparative study was conducted in a tertiary care medical teaching hospital in southern Rajasthan, India. Forty patients with diaphyseal fractures of the radius and ulna bones who presented to the casualty or orthopedic outpatient departments of our institute were included. Patients were divided into two groups, 20 patients in each group and treated by intramedullary nailing (group A) and plate osteosynthesis (group B), and regularly followed up and evaluated for clinical, functional, and radiological outcomes.
Result:
Final results were calculated according to the modified Grace-Eversmann scoring system. In group A, out of 20 cases excellent score was seen in six cases (30%), good score in nine cases (45%), fair score in three cases (15%), and at last, two cases (10%) showed poor results. In group B, excellent score was in eight cases (40%), good score was in eight cases (40%), fair score was in three cases (15%), and at last, one case (5%) was poor in our study.
Conclusion:
Based on our findings, we conclude that for the treatment of diaphyseal fractures of the radius and ulna, both treatment modalities provide equally satisfactory results.
Treatment of nonunion of the ulna and radius bone is a complex task. The most commonly used cortical osteosynthesis for this pathology has a number of significant disadvantages that can lead to delayed union, nonunion and infection. It compromises the result of reconstruction using cortical osteosynthesis plates with screws as a fixator. Thus, active rehabilitation treatment immediately after surgery is risky. Aim. The aim is to demonstrate the clinical observation of surgical treatment by an original method of a patient with nonunion of the ulna due to instability of cortical osteosynthesis. Materials and methods. Patient L. 18 years old. Diagnosis: pseudoarthrosis of the ulna. The condition after metal osteosynthesis is instability. Anamnesis. The patient had closed fracture of both forearm bones a year ago. The fractures were fixed with plates and screws. The fracture of the radius consolidated and osteosynthesis instability with the formation of a pseudoarthrosis occurred on the ulna. Analysing the X-ray data an angular deformation 100 was noted immediately after osteosynthesis. The ulna was reconstructed using a interlocking nail as a fixator and a bone grafting autograft from the ilium. Everyday load and rehabilitation were allowed immediately after the reconstruction. Result. The restructuring and assimilation of the autograft with fragments was noted after 12 months. The rotation function of the forearm was fully restored. The DASH score was 7.5. Conclusion. Thus, the application of the developed reconstruction method using a unterlocking nail as a fixator made it possible to carry out a rehabilitation course immediately after surgery without the risk of fixation failure.
Objective
Plate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.
Methods
We searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.
Results
The total risk difference (RD) was 0.06 (0.04–0.09), indicating that the difference was significant. In the “Reasons for Removal” subgroup analysis, the RD of the “No Symptom” subgroup was 0.07 (95% CI = 0.04–0.11), while the RD of the “Symptoms” subgroup was 0.04 (95% CI = −0.02 to 0.10). In the “Plate Type” subgroup analysis, the RD of the “LCP” subgroup was 0.07 (95% CI = 0.02–0.13), while the RD of the “DCP” subgroup was 0.07 (95% CI = 0.01–0.13). After omitting each study one by one, the RDs were all significant.
Conclusions
Plate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant‐related symptoms, but more reliable evidence is still needed.
Trial Registration
The review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared
Aims: The aim of this study was to compare the functional and radiographic results of patients with forearm diaphyseal fractures after intramedullary nailing (IMN) and plate and screw osteosynthesis. Methods: A total of 58 patients, including 31 patients operated on with the plate osteosynthesis method and 27 patients operated on with the IMN method for forearm diaphyseal fractures between 2017 and 2022, were retrospectively analyzed. The mean age was 35.9±14.5 years in the plate group and 33±13.1 years in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group. Evaluation criteria for functional outcomes were forearm pronation; supination range of motion; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the Grace-Eversmann score. Results: The mean union time was 66.7 days in the plate group and 54.4 days in the IMN group (p=0.039). The mean length of hospitalization was 3.9±3.44 days in the plate group and 2.93±1.49 days in the IMN group. The mean supination range was 72.5±9.9 degrees in the plate group and 72.2±11.8 degrees in the IMN group. The mean pronation range was 81.2±11.7 degrees in the plate group and 80.3±15.5 degrees in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group (p=0.011). According to the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA) classification, 30 cases were classified as type A, 21 cases as type B, and 7 cases as type C. According to the Grace-Eversmann classification, 2 cases in the plate group were classified as unacceptable, 2 were classified as acceptable, 10 were classified as good, and 16 were classified as excellent, while 2 cases in the IMN group were classified as unacceptable, 4 were classified as acceptable, 5 were classified as good, and 16 were classified as excellent. The mean DASH score was 14.74±10.49 in the plate group and 15.11±12.7 in the IMN group. Conclusion: With the advantages of minimal incision, less soft tissue damage, and no evacuation of the fracture hematoma, the union time and follow-up periods were found to be shorter in the IMN group. Thanks to the bearing force of intracanal intramedullary nails, patients were able to move earlier and satisfactory functional outcomes were obtained.
