The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Abstract

Objectives: The results of two different methods applied in the surgical treatment of forearm fractures in adults were evaluated. Methods: Thirty-nine patients who applied to our clinic between 2016-2018 and were treated surgically were included in the study. Twenty-three patients out of these were treated with plate osteosynthesis (group 1), and 16 patients were treated with intramedullary locking nail (group 2). While 14 of the patients in group 1 were male, 9 were female, and the average age was 39.8 years (range; 19-74 years); and 11 of the patients in group 2 were male, 5 were female, and the average age was 36.6 years (range; 18-68 years). Patients were called for monthly check-ups until fracture union. Then, radiographic evaluation was done at 3, 6 and 12 months. The average follow-up time was 26 months (range;12-36 months) for group 1 and 25 months (range;12-35 months) for group 2. The loss of the line of fracture through radiographic imaging of trabeculations or callus formation in the cortex on the anteroposterior and lateral radiographs, and clinically loss of sensitivity on fracture were considered fracture union. In the last controls, while the elbow was at 90 degrees of flexion, the amount of rotation of both forearms was measured by using the goniometer. In the functional evaluation, the system described by Grace and Eversmann and used to evaluate fracture union and forearm rotation was used. Patient satisfaction was evaluated by using the DASH (Disabilities of the Arm, Shoulder and Hand) method. Results: While the union duration in group 1 was 12.3 weeks (range; 8-18 weeks), the union duration in group 2 was 12 weeks (range; 9-16 weeks). There was no statistical difference in terms of union durations (p > 0.05). In Group 1, according to the Grace-Eversmann evaluation, 19 (82.6%) patients had excellent and good results, three (13.1%) patients had acceptable results, and 1 (4.3%) patient had poor results. Forearm pronation of the patient with poor results was less than 60% but his bone union was complete. In group 1, the average DASH score was 15.04 (range; 3-28). In group 2, Grace-Eversmann evaluation showed excellent and good results in 13 (81.3%) patients and acceptable results in 3 (18.7%) patients. Average DASH score was found to be 14.6 (range; 2-34). When Grace-Eversmann criteria and DASH values were compared, no significant difference was found between the two groups (p > 0.05). Vascular nerve injury, tendon injury, radioulnar synostosis, and compartment syndrome were not observed in any patient. Conclusions: The results of the two fixation methods in terms of functional recovery and patient satisfaction were similar in the surgical treatment of forearm double fractures in adults.

Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures

“…In previous studies on adult forearm fractures, the fluoroscopy time in patients who underwent IMN (1.2-7 minutes) was significantly longer than that in patients who were treated with plate osteosynthesis (0-2 minutes). 14 , 17 , 18 , 35 , 37 , 38 In our study, which is consistent with the literature, fluoroscopy time was significantly longer in patients who underwent IMN (21.3 seconds) than in patients who underwent plate osteosynthesis (2.7 seconds). The long fluoroscopy time was the major disadvantage of using IMNs.…”

“…Kibar et al 18 reported that union was achieved at 12.2 weeks in the plate group and 12.1 weeks in the IMN group. Cevik et al 14 noted that union was achieved at 12.3 weeks in the plate group and 12.0 weeks in the IMN group. In our study, the mean time to union in patients undergoing plate osteosynthesis was 13.2 weeks, whereas the mean time to union in patients treated with IMN was 10.9 weeks.…”

“…The results of this study were consistent with those of previous studies, and there was no significant difference in functional scores between the 2 groups as reported in the literature. 14 , 17 , 34 , 39 …”

“…13 The second-generation nails did not have a locking mechanism or compression function, and union with plate fixation could not be performed because they did not provide rotational stability. 14 For this reason, intramedullary nails (IMNs) have not been used in the treatment of forearm fractures for many years.…”

A Comparative Study Between Plate Osteosynthesis and Intramedullary Nailing for Diaphyseal Fracture of Radius and Ulna in Adults

“…We observed that the mean time to union in patients who underwent plate osteosynthesis was 13.4 weeks, whereas in patients in the intramedullary nailing group, it was 10.4 weeks. In our study, the mean time to union in patients was consistent with the literature according to Kose et al [ 27 ], Kibar et al [ 28 ], and Cevik et al [ 29 ]. We used a modified Grace and Eversman scoring system for evaluating the final functional results.…”