Outcome analysis of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults

Abstract

Background: The aim of the study was to evaluate results of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults. The hypothesis behind hybrid fixation is to provide rigid fixation and restoration of forearm length, by ulna plating and large diameter square nail in radius gives rotational stability without any posterior interosseous nerve palsy in proximal radius and ulna fractures. Closed nailing of proximal radius avoid posterior interosseous nerve palsy which has high probability in open surgical approach. Materials and method:We prospectively evaluated 25 patients with closed proximal radius and ulna fractures. 20 males and 5 females with mean age of 30.7 years underwent closed reduction and intramedullary nail fixation in radius and open reduction internal fixation in ulna with plating. The fractures were classified according to the AO/OTA system. The average follow up was 1 year (range 6 months -18 months). Results:The average time to union was 12.77 weeks (10-14 weeks). Union was achieved in all 25 patients in both radius and ulna. Using the Grace and Eversmann rating system7 patients were excellent, 16 good, 1 acceptable and 1 unacceptable results. Using Andersons scale 23 patients had an excellent, 2 unsatisfactory, 0 failure. None of the patients had intraoperative as well as postoperative complications and no posterior interosseous nerve palsy occurred in any of case. Conclusion: Closed reduction internal fixation with use of Hybrid fixation modality in closed proximal radius and ulna fractures has good results. Rigid fixation by ulna plating and rotational stability in radius by large diameter square nail provides almost the same construct as with dual plating with minimal invasive approach. Complication rates are lower as compared to plate osteosynthesis especially with similar union rates in terms of posterior interosseous nerve palsy.

Comparative study between hybrid fixation and dual plating in the management of both bone forearm fractures involving proximal half of radial shaft in adult patients

“…e usual period of immobilization in such xation is up to four weeks and functional outcomes do not vary much with fracture displacement [10,18]. e application of TENs for xation of proximal radial sha fractures has been shown to have favorable functional outcomes in the past few studies [5,6,7] Although the union was delayed in 5 cases in the hybrid xation group, none of the patients developed non-union. e complications related to wound infection, hypertrophic scar and posterior interosseous nerve palsy were observed in the dual plating group.…”

“…Intramedullary elastic nailing and plate osteosynthesis have been the commonly used modalities for the treatment of forearm fractures in older children and adults, respectively [3,4,13,14]. e least explored option of hybrid xation with one of the two fractured bones being treated with plate osteosynthesis and other with an intramedullary device in adult patients has been analyzed in very few studies [5,6,7].…”

“…For forearm fractures with involvement of proximal half of the radial sha , the plating methods require careful dissection around the posterior interosseous nerve and can potentially injure the same because of its variable location [8]. Moreover, the muscular bulk in the proximal forearm requires extensive exposure and periosteal stripping which may lead to muscle necrosis, so tissue injur y and even compartment syndrome [4][5][6][7]. e closed elastic intramedullary nailing for these fractures has been successfully used in young and older children with functional outcomes comparable to plating methods [9].…”