Bone Forearm Fractures Research Articles

Functional Outcome of Intramedullary Kirschner Wire Fixation of Unstable Radius-Ulna Fractures in Children

Pediatric patients with unstable radius-ulna fracture can be treated with intramedullary Kirschner wire fixation. Objective: To determine the functional outcome of Intramedullary Kirschner Wire fixation in unstable radius-ulna fractures in children. Methods: All pediatric age patients were enrolled into the study with unstable radius and ulna fracture. Informed consent was taken before study. Proper history, examination and X-rays of the forearm was taken after taking consent from the guardian of the patient. Under general anesthesia and tourniquet, control radius was first fixed through a small volar incision by drilling a k wire at fracture site in radius so that the wire exits on the dorsolateral side of the radius. The fracture was than reduced and the wire tapped with hammer to the radial head. Similarly, ulna was fixed by first drilling the wire up to the olecranon process and after reduction of the fracture down to the styloid process. After checking stability both bones, both wounds were washed with normal saline and closed in reverse order and above elbow cast was applied for three to four weeks. Results: In this study, as per functional outcomes, 5(4.0%) patients had good outcome, 80(64%) patients had excellent outcomes whereas 40(32%) patients had poor outcomes. Conclusions: This study demonstrates excellent functional outcome of Intramedullary Kirschner Wire fixation in unstable both bone forearm fractures in children.

Single dorsal incision approach for plate fixation of radius ulna midshaft fracture; interesting case report

Radius and ulna shaft fractures, also known as both bone forearm fractures, are common fractures caused due to direct or indirect trauma. Open reduction and internal fixation with plating by two separate incisions is a standard and widely accepted mode of fixation. We report a case where we approached the fracture with a single dorsal incision. An eighty years old female had fractures of both radius and ulna shaft with Gustilo Anderson type two open injury. We managed the patient with single-stage debridement, open reduction, and dynamic compression plate (DCP) fixation of both bones with a single dorsal curvilinear incision and followed up postoperatively for one year. At the end of the last follow-up, the patient had no pain with a full range of movement. There were no wound-related issues. Radiologically complete union occurred without complications mentioned in the literature, such as synostosis.: We found that under specific circumstances such as open injury where two separate incisions for radius and ulna are inappropriate, a single dorsal curvilinear incision for radius and Ulna midshaft fractures is a safe and effective alternative method.

A STUDY OF MANAGEMENT OF DIAPHYSEAL FRACTURES OF BOTH BONES FOREARM WITH DYNAMIC COMPRESSION PLATING

The forearm serves an important role in the functioning of the upper extremity. Hence aggressive management through good anatomical reduction and internal xation of these fractures has become important. The aim of treatment is to re-establish the normal anatomy and good functional outcome. Early rehabilitation started in the immediate postoperative period to prevent disability to a large extent. The aim of this study is to assess the results of fractures of shaft of both bones of forearm with dynamic compression plate (DCP).30 patients with acute diaphyseal fractures of the radius and ulna were treated with open reduction and internal xation with dynamic compression plate and screws at Osmania general hospital, between November 2016 and April 2019. Cases were taken according to inclusion and exclusion criteria i.e., Adults, both males and females with diaphyseal fracture of forearm bones above the age of 18yrs. Medically unsuitable and patients not willing for surgery were excluded from the study. In our series of 30 cases there were 25 males and 5 females, with average age of 32.6yrs. Good or full range of mobility of elbow and wrist joints with excellent, satisfactory results was present in 28 patients (94%), 1(3%) patient having restriction of elbow motion and pronation and supination and 1(3%) patient with ulnar non-union which recovered with bone grafting. With rigid/anatomical internal xation, dynamic compression plate is a good xation for displaced diaphyseal fractures of the forearm bones. Adherence to AO principles, strict asepsis, proper post operative rehabilitation and patient education are more important to obtain excellent results. Also, external immobilization was not required in cooperative patients.

A PROSPECTIVE STUDY ON THE ROLE OF INTRAMEDULLARY NAILING IN ADULT DIAPHYSEAL FOREARM FRACTURES, DURING COVID-19 PANDEMIC, HYDERABAD, INDIA

Background & objectives: Fractures of forearm bones may result in severe loss of function unless adequately treated. Intramedullary nailing is less traumatic than plate-and-screw xation along with preservation of fracture hematoma. Idea of primary bone healing was one of the reasons why intramedullary nailing became disregarded in favour of plate and screw xation. The COVID-19 pandemic caused surgeons, to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. This study aims to analyse functional outcome and advantages of intramedullary nailing (Titanium ElasticNails, Square or Rush nails) in treatment of adult diaphyseal forearm fractures during the pandemic. Methods: A prospective study on 16 cases of closed simple diaphyseal forearm fractures in the age group of 20 to 60 years from April 2020 to Jan 2021 managed with intramedullary nailing. Results were evaluated based on mode of anaesthesia, operating time, blood loss, average union time, modied Grace and Eversmann scoring system for functional outcome. Interpretation and Conclusion: Most cases received brachial block with mean operating time of 40 minutes. Blood loss was minimal. The average union time (radiologic evidence of callus) was 7 weeks. Functional outcomes were excellent in 12 patients (75%), good in 3 patients (18.75%) and poor in 1 case. Intramedullary nailing is a reliable but less invasive alternative for adult diaphyseal forearm fractures during pandemics with excellent stability and predictable results.

Plaster versus Ortho-Glass®: Does Initial Splint Material Matter in Pediatric Forearm Fracture Outcomes? A Randomized, Prospective Trial

Background: Various techniques of non-operative management of pediatric forearm fractures have proven to be successful in avoiding surgical risk and obtaining acceptable outcomes for patients. However, the ability of plaster versus fiberglass splint material to maintain reduction of these fractures has not been compared. Our goal was to determine whether splint material affects the success of non-operative management of pediatric forearm fractures.Methods: All patients aged 0-18 years with a traumatic forearm fracture requiring reduction were enrolled prospectively and randomized to fiberglass (Ortho-Glass®, Essity Medical Solutions, Charlotte, NC) or plaster sugartong splints. A total of 230 patients met inclusion criteria: 90 randomized to plaster and 140 to fiberglass. Patients were stratified based on location of fracture: distal radius fractures (DRF), middle both bone forearm fractures (BBFFx), and proximal BBFFx. Radiographic outcomes including residual deformity and clinical outcomes including conversion to surgery were evaluated in all patients. Statistical analysis was performed with t-test, Wilcoxon rank sum, Chi-Square, or Fisher's exact tests where applicable.Results: Radiographic and clinical outcomes were similar between fiberglass and plaster splints. Overall, only 2.6% of patients required conversion to surgery, 1.1% of the plaster cohort and 3.6% of the fiberglass cohort (p=0.41). No patients required re-reduction with sedation. At final follow-up, 32.5% of middle or proximal BBFFx and 1.3% of DRF healed in “unacceptable” alignment according to classically described guidelines.Conclusions: There is no difference in the effectiveness of fiberglass or plaster sugartong splints for initial immobilization of pediatric BBFFx and DRF. Rates of conversion to surgery were lower in both groups than previously described. However, there was a trend toward treating “unacceptably” aligned forearm fractures non-operatively and more research is indicated to determine the long-term clinical significance.Level of Evidence: Level IKey Concepts•Splint material is not a contributing factor to maintaining reduction of distal radius and both bone forearm fractures in children.•Closed reduction and sugartong splinting of pediatric distal radius and both bone forearm fractures provide favorable outcomes with low surgical conversion rate.

Functional and Radiological Outcome of Conservatively Managed Fracture of Radius and Ulna Forearm Bone in Paediatric PopulationA Longitudinal Interventional Study

Introduction: Fractures of the shaft of both bones of forearm are one of the most common fractures in the paediatric age group. There is often a difference of opinion regarding the management of these fractures. Though, there has been an increasing inclination towards surgical correction of these injuries, conservative management is still very popular because of the advantage of good bone remodelling potential in children. Loss of reduction is a known complication of conservative method of treatment. Assessment of the cast index can serve as a tool for the prediction of failure of the conservative management. Aim: To analyse the functional and radiological outcomes of both radius and ulna forearm bones shaft fractures. Materials and Methods: This longitudinal interventional study was conducted in the Department of Orthopaedic Surgery, at King George’s Medical University, Lucknow, Uttar Pradesh, India. The duration of the study was one year 11 months, from June 2017 to May 2019. A total of 196 (156 males and 40 females) patients were included in the study, who presented with closed diaphyseal fractures of the radius and ulna, and were managed conservatively. The patients with acceptable reductions were followed-up at three weeks, six weeks, three months and six months. The functional and radiological parameters were assessed, analysed and the cast index was estimated at each follow-up visit. Chi-square test was performed on the numerical/frequency displays of the dichotomous variables. Student’s t-test with a 95% confidence interval was performed to compare the means of the two groups. Results: The changes in angulation for Anteroposterior (AP), as well as, lateral view of both radius and ulna were significant at each follow-up (p<0.001), but the fracture reduction was found acceptable as per protocol. The loss of reduction was seen equally in male and female patients, only on the left-side and only in the middle third of both bone forearm fracture, but no significant association was found between sex, laterality, site and loss of reduction. The final Range Of Motion (ROM) obtained at elbow, forearm and wrist were all in the functional range at six months follow-up. There were two cases of failure, both above 10 years of age having high cast index and greater angulation in ulna in the prereduction phase. Conclusion: Conservative treatment remains the gold standard for management of paediatric bones forearm fractures with very good functional outcome. A high cast index can be used to predict failure of the conservative management.

Single Bone Intramedullary Fixation in Pediatric both Bone Forearm Fractures

Single Bone Intramedullary Fixation in Pediatric both Bone Forearm Fractures

The Ulnar Olecranon-Coronoid Notch Angle Affects Terminal Elbow Extension in Children and Adolescents.

Limitations to terminal elbow extension (TEE) in pediatric populations have been commonly associated with the degree of ligamentous laxity and not bony factors. Ligamentous laxity, quantified through the Beighton score, is criticized for unreliably assessing joint mobility. This study aims to show that the olecranon-coronoid notch angle (OCNA) affects TEE in healthy children and adolescents. A retrospective study of 711 pediatric patients treated for upper extremity and shoulder injuries was cross-sectionally studied at 2 tertiary centers from 2014 to 2021. Radiographs were used to measure the OCNA, humerocondylar angle, proximal anterior ulnar angle, and the presence of secondary centers of ossification. A 2-axis goniometer measured clinical TEE to a firm endpoint. The statistical analysis studied the relationships between OCNA and TEE and the effect that age and sex have on these measurements. Increased TEE was associated with increased OCNA (P<0.001) when accounting for age and sex. The average OCNA was 30.0 degrees (7.5 degrees), and the average TEE was 5.6 degrees (8.0 degrees). There was a difference in OCNA between subjects who had elbow hypoextension, normal TEE, and elbow hyperextension (P<0.001). The most common injuries were distal radius fractures (182, 26%), elbow sprains and contusions (111, 16%), distal both bone forearm fractures (95, 14%), single or both bone shaft fractures (77, 11%), and supracondylar fractures (74, 11%). These results show that the orientation of the opening of the olecranon-coronoid notch influences the arc of TEE motion in a healthy pediatric population. The notch restrains TEE by activating the bony block mechanism between the olecranon apophysis and the olecranon fossa. The measurement of the OCNA can serve as a reproducible and quantitative method to predict hypomobility to hypermobility of TEE motion. Prognostic study: Level II.

Recovery of Forearm Bone Strength After Plate Removal: A Finite Element Analysis Study

The purpose of this study was to estimate the bone strength after plate removal over time and to investigate the progression of bone strength recovery. A consecutive series of 31 patients was investigated to evaluate bone strength before and after forearm plate removal. Patients who were included underwent plate fixation for forearm diaphyseal fractures and were scheduled for plate removal. Computed tomography (CT) scans of the entire length of the bilateral forearms were taken before plate removal and at 1, 3, and 6 months after surgery. Patient-specific CT-based finite element analysis was used to predict the forearm bone fracture strength against an axial load (N), defined as the bone strength. Bone strength was estimated by patient-specific CT-based finite element analysis at each time point. The mean age of the patients was 40.4 years. The mean time between plate fixation and removal was 27.5 months. Bone strength before the removal was estimated as reduced to 47% of that of the uninjured side. This was constant regardless of age group, involvement of the radius or ulna, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture, or type of plate. Bone strength at 1, 3, and 6 months after removal was estimated to be 66%, 85%, and 97%, respectively. The bone strength of the distal ulna was weaker than that at the other sites in the forearm and showed delayed recovery. Bone strength after plate removal showed recovery within 3-6 months and was fully recovered by 6 months. The degree of recovery of bone atrophy varies from site to site, and patients should be careful about refracture after removal. Clinicians should be aware that bone strength may not be sufficiently restored even 6 months after plate removal of forearm fractures.

Management of both bone forearm fracture using titanium elastic nailing system in pediatric age group

Background: The management of pediatric forearm fracture has been a dilemma to surgeon. Conservative treatment with cast still is the preferred treatment. Never the less old children and proximal fracture warrants some form of internal fixation. Aims and Objective: The aims of this were to analyze the role of titanium elastic nailing system in fixation of pediatric forearm fractures and its associated complications. Materials and Methods: Over 3 years, 103 patients were enrolled in our institute. After obtaining consent and preanesthetic check-up, patients were scheduled for surgery, where internal fixation was done using titanium elastic nailing system. Patients were followed up every month for 3 months and then every 3 months interval for 8 months. The time to union and functional score were assessed using modified Flynn score. Results: Among the 103 patients, 63 (61.16%) were in the age group of 7–13 years. Mean age was 11.72±3.50 years (range 4–18 years). Seventy-eight (75.72%) patients were male and fall from height was the most common 66 (64%) mode of injury. Radiological union occurred in most 54 (52.42%) of the patients at average 5–7 weeks. As per the modified Flynn criteria, 82 (79.61%) cases had excellent functional outcome, 11 (10.67%) cases good, 4 (4.12%) fair, and 6 (5.82%) had poor outcome. Neuropraxia was seen in 8 (7.76%) cases and rupture of extensor pollicis brevis was seen in 4 (4.12%) patients and treated accordingly. All the patients regained full functional recovery. Conclusion: TENS is an effective, safe, reliable, and easily reproducible technique for the management of pediatric forearm fractures. It has advantage of preserving the fracture hematoma, providing relative stability to ensue early rehabilitation and minimally invasive nature.

Various modalities of management of segmental fractures of long bones

Introduction: Segmental long bone fractures in high energy injuries are a challenging combination of bone and soft-tissue damage and loss. The state of the surrounding soft tissues and the local blood supply to the bone are the most important factors determining the tendency of the fracture to heal. Objectives: To study the efficacy and safety of various method of treatment in segmental fractures long bones and various complications associated with it. Materials and Methods: 20 patients with segmental fractures of long bones, satisfying the inclusion criteria, who were treated with various modalities of management were included in the study.The fractures were evaluated clinically as well as radiologically and the modality of management was based on the type of fracture and associated injuries. Out of 10 tibial fractures, 6 were treated with static intramedullary nail, and 2 with external fixator 2 conservatively. Out of 5 femoral fractures,4 were treated with intramedullary nail. Out of 2 humerus fractures 2 were treated with dynamic compression plate technique. Out of 3 both bone forearm fractures 3 were treated with dynamic compression plate technique.

Functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm

Background: Excellent results for plate fixation in displaced diaphyseal fractures of both bone of forearm have been reported by various authors, but only a few authors have focused on plate fixation in the management of open diaphyseal fractures of both the radius and ulna. Aim: This present study is aimed to assess the functional outcome of dynamic compression plating and intramedullary nailing of diaphyseal fracture of both bones forearm. Methods: This series consists of 50 cases of fracture both bone of forearm by open reduction and internal fixation with dynamic compression plate, closed reduction with intramedullary nailing by TENS between the period of 2 years at a tertiary care hospital after obtaining the clearance by the hospital ethical committee. Of the above cases 25 patients were treated by open reduction and internal fixation with dynamic compression plate and 25 cases were treated with closed reduction and internal fixation with TENS. Results: Even though, plate osteosynthesis is still the most commonly used form of fixation in adult both bone forearm fractures, both titanium elastic nail and interlocking nail fixation are relatively newer techniques which offer a viable and more efficient alternative especially in fixation of fractures involving shafts of radius and ulna. Conclusions: Increased incidence of forearm fractures was probably due to increasing road traffic accidents and fall. Forearm fractures occurs more commonly in second and third decade. Male predominance was seen. Open reduction and internal fixation can be considered as the treatment of choice if there is no contraindication. It is important to maintain length, opposition, axial alignment, and rotational alignment in order to restore good range of movement of forearm. This is achieved in the present study.

IS LOCKED COMPRESSION PLATE BETTER THAN LIMITED CONTACT DYNAMIC COMPRESSION PLATE IN TREATMENT OF CLOSED MIDDLE THIRD RADIUS AND ULNAR FRACTURES IN ADULTS: A SHORT-TERM COMPARATIVE STUDY

Background: Forearm bone fracture is a commonly encountered fracture. The inception of locking compression plate (LCP) has revolutionized fracture management. With their dramatic success for articular fractures, there is a speculation that they might be more appropriate for diaphyseal fractures as well. Objective: To compare internal fixation of closed, middle third forearm fractures with LCP and limited contact dynamic compression plate (LC-DCP) in adults with respect to union rate, implant failure, functional outcome, and infection rate. Methods: Twenty-two patients with closed, middle third fractures of both the forearm bones were involved in this prospective, randomized, controlled study, which took place between February 2019 to January 2021. They were segregated into two groups based on open reduction and internal fixation with LCP (n=11) and with LC-DCP (n=11). Postoperative follow-up intervals of 1, 2, 6 weeks and 3, 6 months. The patients were assessed for implant failure, fracture union and function outcome of Andersons’ criteria to assess union, forearm rotation, and wrist flexion-extension, and disabilities of the arm, shoulder and hand (DASH) score for patient related outcome at the latest follow up. Results: The mean age of the patients was 30.9 years (range 19-47 years) with mean follow up about of 2 years. The union rate in LCP group was (100%) whereas in LC-DCP was (81.8%), the p value was (0.4), which is not statistically significant. The p value for Quick DASH score and Anderson’ criteria were (0.8 and 0.43), respectively which is also not statistically significant. No incidence of implant failure in both groups. Conclusion: Although LCP is an effective treatment alternative and may have a subtle edge over LC-DCP in the management of these fractures, their supremacy could not be certified. We deduce that surgical planning and expertise rather than the choice of implant are more pivotal for outstanding results. Keywords: Limited contact dynamic compression plate, locking compression plate, closed, middle third fractures, both bones of forearm Citation: Chhaily ZA, Joda AI, Abd Ali AS, Ali ZH. Is locked compression plate better than limited contact dynamic compression plate in treatment of closed middle third radius and ulnar fractures in adults: A short-term comparative study. Iraqi JMS. 2022; 20(1): 146-153. doi: 10.22578/IJMS.20.1.19

Dynamics of hematological parameters and acute phase reactions for osteosubstitution by autofibrin and hydroxyapatite ceramics with β-tricalcium phosphate fragmentary bone fractures in dogs

Osteo-replacement materials are considered to be the most promising direction in solving the problem of restoring the regenerative potential of bone tissue, especially fragmentary fractures. However, the mechanism of their influence on the histomorphology of bone regenerates and the pathochemical phase of reparative osteogenesis require further and comprehensive justification. The aim of the study was to establish the dynamics of hematological parameters and acute phase response to osteosubstitution by hydroxyapatite ceramics with β-tricalcium phosphate and platelet-enriched autofibrin in fragmentary bone fractures in dogs. Control and research groups of animals were formed, each of which included dogs with fractures of both shoulder and forearm bones, which came in 2019- 2021 to the clinic of small pets of the Faculty of Veterinary Medicine of Bila Tserkva NAU. After general and local anesthesia, extracortical osteosynthesis and replacement of bone defects were performed: in the first experimental group (n = 10) autofibrin enriched with platelets (PRF), and in the second (n = 10) - its combination with hydroxyapatite ceramics (PRF + HA/β -TCP-700); in the control group (n = 10) the defects were left to heal under the blood clot. Blood samples for hematological and biochemical studies were taken after injury no later than 24 hours and on the 3rd, 7th, 14th, 21st and 42nd day after osteosynthesis. In peripheral blood, the number of erythrocytes, platelets and leukocytes was determined by conventional methods, and hemoglobin - hemoglobin cyanide. The content of nitric oxide (NO) in the blood serum was determined by the method of Green in the modification of Golikov, haptoglobin - by reaction with rivanol kits PJSC "Reagent" (Ukraine) and α2-macroglobulin - by KM Veremeenko. Statistical processing of the results was performed using the program Statistica 10 (StatSoft Inc, USA, 2011). It was found that bone trauma in dogs is accompanied by a decrease in peripheral blood of erythrocytes by 1.3 times (p &lt;0.001) and an increase of 1.1 times (p &lt;0.05) the number of leukocytes with a tendency to increase hemoglobin and platelets, compared with indicators of clinically healthy animals. After osteosynthesis in all groups leukocytosis developed. During osteosubstitution, the intensity and duration of the leukocyte reaction decreased significantly. In the first experimental group, the peak of NO concentration occurred on the 21st day, and in the case of combined osteosubstitution, the phase of its changes was noted, which had two peaks: on the 7th in 1.5 and on the 21st in 1.8 (p &lt;0.001) is several times higher than in the control group. The concentration of haptoglobin after bone injury in dogs increased 1.1 times (p &lt;0.001) compared with clinically healthy animals and reached its peak in all groups on the 3rd day (p &lt;0.001). No changes in α2-macroglobulin concentration were observed in the groups during the entire study period. Combined osteosubstitution by calcium-phosphate ceramics with platelet-enriched fibrin induces early osteogenic processes at a lower intensity of the acute phase reaction at the phase peaks of nitric oxide - an inducer of angiogenesis, which indicates the viability of animals. Key words: nitric oxide, acute phase proteins, reparative potential, platelets.

Evaluation of functional outcome of forearm fracture in children treated with elastic nail (TENs)

Background: Forearm fractures are one of the most common injuries sustained by children and both bone forearm fractures are estimated around 40% of all pediatric fractures. Pediatric forearm fractures occur in approximately 1 in 100 children per year. Forearm shaft fractures in children are usually treated with closed reduction and cast immobilization and a good functional outcome is obtained, but few patients with gross displacement, angulations, soft tissue swelling due to edema, children nearing skeletal maturity, proximal third fractures, open fractures and displacement after closed manipulation and cast immobilization require surgical intervention. Greater controversy exists regarding the optimal method of fixation in children. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either intramedullary nails or open reduction and internal fixation with plates. The purpose of this study was to investigate the indications, techniques, clinical results, functional outcomes, possible complications and means of avoiding them in unstable forearm fractures in children treated with titanium elastic nails (TENs). Methods: Our prospective interventional study included Forty five children after application of inclusion and exclusion criteria, consent for study was taken from the parents.

Closed reduction and internal fixation with titanium elastic nailing system in pediatric both-bone forearm fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The present study is designed to analyse the postoperative clinical and functional outcome of closed reduction and internal fixation of pediatric both-bone forearm fractures with titanium elastic nailing system (TENS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 32 patients in the age group of 5 to 15 years with fracture both-bone forearm underwent closed reduction and internal fixation with TENS at our hospital. Patients with displaced fractures having angulation more than 10° and rotation of more than 45° or fractures with unacceptable reduction post conservative management were included in this study. For functional outcome, upper extremity rating scale (UERS) was used to evaluate the range of motion and grip strength.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Patients were followed up for a period of 6 months. In all cases fracture united in the range of 6-14 weeks without any malunion. All 32 cases had excellent outcomes according to UERS score. Two patients had deficient forearm pronation of 10° and 15° respectively. Skin irritation and implant impingement was seen in two patients each at final follow-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Closed reduction and internal fixation with TENS seems to be a good treatment option for fixation of pediatric both bone forearm fractures. It gives excellent functional outcome in terms of range of motion and grip strength without any major complications.&lt;/p&gt;

Clinical and Radiological Results of Close Reduction and Intramedullary Elastic Nailing in Pediatric Both Bone Forearm Fractures

Clinical and Radiological Results of Close Reduction and Intramedullary Elastic Nailing in Pediatric Both Bone Forearm Fractures

Forearm Plate Fixation: Should Plates Be Removed?

Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also studied factors associated with plate removal. We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primary plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients with nonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plate removal were identified using multivariable analysis. Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of the fractures with retained plates. Refractures were independently associated with plate removal (OR: 3.7, 95% CI: 1.2-11.7, P=0.023) and was more frequent in the radius (OR: 2.4, 95% CI: 1.0-5.8, P=0.06). A refracture after implant removal occurred within 3 months after removal. Ulnar plates were removed more often compared to radial plates (OR: 2.6, 95% CI: 1.4-4.7, P=0.002) as were plates used for type A fractures compared to type C fractures (OR: 3.2, 95% CI: 1.1-9.2, P=0.032). The rate of refracture is higher after plate removal compared to patients who did not have plates removed. Although uncommon, refractures of the radius tend to be more common than a refracture of the ulna. If the implant is symptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant rather than remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removal is a consideration.

Evaluation of Outcome of Percutaneous K-wires Fixation of Pediatric Both Bone Forearm Fractures

Evaluation of Outcome of Percutaneous K-wires Fixation of Pediatric Both Bone Forearm Fractures

Dynamic Compression Plate versus Locking Compression Plate Fixation in Adult Forearm Fractures: A Prospective Interventional Study

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters, and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment, and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a Locking Compression Plate(n=15) or a Dynamic Compression Plate(n=15) at the Dr.D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 patients (86.7%) each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although it was statistically insignificant (p-value= 0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes.