Comparative study of closed intramedullary elastic nailing vs plate osteosynthesis in diaphyseal fractures of both bones forearm in adults

Abstract

Background: In the current era, fractures of forearm bones have become more common. The forearm serves an important role in the functioning of the upper extremity. Hence aggressive management through good anatomical reduction and internal fixation of these fractures has become a necessity. Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The purpose of this study was to assess and compare functional results of plating and nailing in fracture stabilization. Aims of Study: 1.To evaluate the results of internal fixation of diaphyseal fractures of both bones forearm treated by plate osteosynthesis and closed intramedullary elastic nailing. 2. To compare the functional results of the two groups treated with plate osteosynthesis and closed intramedullary elastic nailing. Methods: Retrospective and prospective study with the sample size of 20 patients with both bone forearm fractures. 10 patients were treated with dynamic compression plating and remaining 10 with intramedullary elastic nails. Results were assessed by time for union, type of fractures, range of motion of elbow and wrist joint, complications and functional assessment were done by Grace-Eversmann Criteria and DASH questionnaire Results: Average surgery time in plate osteosynthesis group was 70 minutes, and in closed nailing group was 50 minutes. In plate osteosynthesis group radius showed union in 9 (90%) patients and ulna in 10 (100%) of patients, and 1 deep infection in plate osteosynthesis closed nailing group both radius and ulna resulted in 100% union rate. In plate osteosynthesis group there was 1 deep infection, no implant failure, and 1 delayed union. Functional results in plate osteosynthesis group were excellent in 7 of patient, satisfactory in 2 of patients failure in 1. There was no unsatisfactory result in this group. In closed nailing group result were excellent in 7, satisfactory in 2, unsatisfactory in 1 and no failure Conclusions: Our experience indicates that the advantage of closed intramedullary nailing for fractures of both bones forearm are that it allows high rate of osseous union, and it requires less surgical exposure and operative time, less risk of infection than plate osteosynthesis for diaphyseal fractures of both bones forearm in adults. The disadvantage of this system is that post-operative immobilization is required until bridging callus is observed at the fracture site. We conclude that closed intramedullary nailing is not superior to plate fixation but can be considered as an alternative to that method for diaphyseal forearm fractures in adults.

Management of Radius and / Or Ulna Fracture by Screw Intramedullary Nail in Skeletally Mature Patients

“…This study was quite similar to the current research work as an excellent result according to Anderson scoring system was shown in 13 cases (61.9%), which is quite near to the results shown by the study mentioned above with 50 cases (65.74%). Garampalli et al 23 published a paper with contradictory findings compared to our study. They described the disadvantage of requiring postoperative immobilization until the bridging callus was discovered at the fracture site.…”