Diaphyseal Forearm Fractures Research Articles

A comparative study of internal fixation of forearm fractures using locking compression plate and dynamic compression plate

Background: Fractures of forearm bones are common in direct trauma often while protecting one’s head, road traffic accidents, fall from height and sports activities. Open reduction and internal fixation are the treatment of choice in these cases. Locking Compression Plate (LCP) is a new fixation device in treating these fractures. This study has been carried out to compare the role of Locking Compression Plate (LCP) with Dynamic Compression Plate (DCP) in treating these fractures. Methods: A prospective study was done from September 2017 to March 2019, including forty eight patients with fractures of radius and ulna. In Group I (DCP group), twenty four patients were subjected to open reduction and internal fixation with 3.5 mm stainless steel DCP and non-locking screws. In Group II (LCP group), 24 patients were managed by open reduction and internal fixation using 3.5mm stainless steel LCP and locking head/non-locking screws. All patients were followed up at monthly interval until union. Clinical assessment regarding functional outcome was done at the final follow-up.Results & Conclusion: The mean union time in Group I (DCP group) was 13.67 weeks (range, 8-24 weeks, SD3.67). In Group II (LCP group), the mean union time was 16.25 weeks (range, 12-24weeks, SD3.14). Excellent & satisfactory results were observed in 87.5% cases in Gp I and 91.67% cases in Gp II. On statistical analysis, there was no significant difference in the mean union time and functional outcome in Gp I and Gp II. Both internal fixation devices were equally effective in treating diaphyseal fractures of forearm.

Hybrid fixation for adolescent both-bones diaphyseal forearm fractures: Preliminary results of a prospective cohort study

IntroductionBoth-bone forearm fractures account for 3.4% of all pediatric fractures and 26% of all pediatric upper extremity fractures. Although non-operative management remains a feasible treatment option for children older than 10 years, they have a higher incidence for malunion due to their limited bone remodelling potential. Therefore, surgical intervention could be advocated for this age group, however the optimal method of surgical fixation in this age group remains controversial.Authors wanted to evaluate hybrid fixation (plating of ulna & elastic nail for radius) of adolescent both-bone forearm fractures in a large single-institution cohort of patients. MethodsA single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from February 2016 to February 2019.A total of 60 patients (age 10–16 years) with both-bones forearm fracture were enrolled. Patients were assessed radiographically for union as well as clinically using the “Outcome Grading System” developed by Martus et al. for functional assessment of surgical management of pediatric forearm fractures using forearm rotation range of motion & complications rate. ResultsAt final follow up for each patient (24 months) Union was achieved in all cases. Delayed union occurred in 4 patients (2 radii & 2 ulnae) with no case of combined radius & ulnar delayed union. At final follow up, the mean supination range was 81.27° ± 4.1°, while the mean pronation range was 68.17° ± 3.03°. The “Outcome Grading System” results were: 48 cases (80%) scored excellent, 10 cases (16.7%) scored good & 2 cases (3.3%) scored fair. ConclusionHybrid fixation method in adolescent both-bones forearm fracture could be a viable option in managing these injuries & may reduce the problem of ulnar non-union encountered when using elastic stable intramedullary nail (ESIN) in that age group. Level of evidenceLevel II, Therapeutic study.

Functional outcome of closed diaphyseal fractures of both bone forearm in adults treated by small dynamic compression plate fixation in radius & intramedullary nail fixation in ulna

Introduction: Both bone forearrn fractures represent approximately 10-14% of all fractures.It is advocated that these type of fracture should be treated surgically, Fixation of fracture is done by either plate or nail or both. Aims and objectives: To study and evaluate functional outcome by GE (Grace & Eversmann Rating) rating & Anderson et al. score in closed diaphyseal fractures of both bone forearm in adults treated by SDCP (Small Dynamic Compression Plate) in radius & intramedullary nail in ulna. Method and Materials: Present study included 60 patients aged 18-45yrs having fracture both bone forearm admitted in OPD and emergency at MBGH Udaipur from 1stjanuary 2017 to 31stjuly 2018 & divided in 4 groups on the basis of location of fracture site of both bones, A (both upper third), B (Both Middle Third), C (both lower third) & D (Both At Different Site). All patients were operated with intramedullary Talwalkar’s square nail in ulna & SDCP in radius. Functional outcome using GE rating and Anderson et al. score and complications were observed with 9 months clinic radiological follow up. Result: Maximum no. of patients were in group B which is 36(60%). Mean union time for was minimum for B (15.41 Wks.), maximum in A (20wks) with overall 16.25wks. Average roation arc was 140.51 (90.32% of the reference mean). In GE patients showing excellent result were overall 56.6%& maximum 70% in D, while unacceptable in 6.67%. In Anderson et al. score patients showing excellent result were 63.33% overall with maximum 80% in D, while failure in 5%. Conclusion: Fracture union time was minimum in group-B & maximum in group A(because of prolong immobilization and delayed physiotherapy).Both scoring system showed best results with variable site involvement (D) because of better stability, early mobilization & good rotation arc. Considering GE & Andrson et al. scores with overall union rates & rotation arc, SDCP in radius and square nail in ulna is a good fixation modality for fracture forearms especially I n group D.

Long-term results of elastic-stable intramedullary nailing (ESIN) of diaphyseal forearm fractures in children.

Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.Level of Evidence: Level III; retrospective study; therapeutic study.

Functional outcome of diaphyseal fractures of forearm in adolescents treated with TENS

<p class="abstract"><strong>Background:</strong> A retrospective case series study was done on forearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system). Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group.</p><p class="abstract"><strong>Methods:</strong> We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year. </p><p class="abstract"><strong>Results:</strong> In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patient had poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that TENS in both bone forearm fractures in adolescent age group in terms of union and range of motion is a minimally invasive and effective method of fixation.</p>

Functional Outcome of Displaced Diaphyseal Both Bone Forearm Fracture in Children Treated with Elastic Stable Intramedullary Nails

Introduction: Pediatric forearm fractures are most commonly managed by closed reduction and above elbow cast. Failure to achieve anatomical initial reduction, tight cast and re-displacement within cast leading to malunion are common complication. Elastic stableintramedullary nailing for such fracture gives more predictable result with minimal morbidity. We studied on functional outcome of such fracture treated operatively with elastic stable intramedullary nail in our center.
 Methods: This prospective descriptive study was done in Nepalgunj Medical College Hospital, Nepalgunj between January 2015 to May 2017.It included 47 pediatric patients (5-15 years) with displaced both bone forearm diaphyseal fracture. All fractures were fixed with elastic stable intramedullary nails of appropriate size under general anesthesia. Cases were followed up at 1, 2, 4, 6, 8, 10, 12 weeks and at 6 month functional outcome was evaluated using price criteria. Data were entered in structured proforma and statistical analysis was carried out using SPSS 20.0.
 Results: Out of 47 cases included in our study, mean age of patient was 9.7 years (range 5-15 years). 31(65.9%) cases were male and16 (34.1%) were female. 42(89.4%) cases had closed fracture and 5(10.6%) had grade I open factor. 40(85.1%) cases were operated by closed technique. Average hospital stay was 2.7±1.8 day (range 2-5days). Radiological union was achieved on 6.5±2.7 weeks (range 6-11weeks).Functional outcome in final follow up at 6 month was excellent in 36(76.6%), good in 9(19.1%) and fair in 2(4.3%) cases. Superficial surgical site infection was seen in 3 cases (6.3%) and exposure of nail tip was seen in 2 cases (4.2%).
 Conclusion: Elastics table intramedullary nail for displaced pediatric both bone forearm diaphyseal fracture is biological osteosynthesis, simple and reproducible treatment with excellent functional outcome with minimal morbidity.

Functional outcome of surgical management of fracture both bones forearm in adults using LC-DCP

Background: Forearm bone fractures are commonly encountered in today’s industrial era due to road traffic accidents, contact atheletic participation and falls from a height. Treatment by closed reduction and cast immobilization risks a poor functional outcome with unsatisfactory results reported in up to 92% of cases, usually caused by malunion, nonunion, or synostosis. Open reduction and internal fixation with plating is generally accepted as the best method of treatment for displaced diaphyseal fractures of the forearm in the adult. This study will be conducted to analyze diaphyseal fractures of the forearm treated with limited contact dynamic compression plate and will document their clinical and functional outcome. Materials and Methods: A prospective, non-controlled, non-randomized, non-blinded observational study, on patients with diaphyseal fractures of both bone forearm admitted in Department of Orthopaedics, RIMS, Ranchi during two years time interval (from 1st October 2015 to 30thSeptember 2017) in the age group of 19 to 70 years with a mean age of 36.29 years was conducted. 53 Patients were selected for the study from those presenting to our hospital. The outcome was assessed based the disabilities of arm; shoulder and hand (DASH) score. Results: Results were analysed according to disabilities of arm; shoulder and hand (DASH) score. Excellent functional outcome result in 40 patients (80%), satisfactory in 5 patients (10%) while remaining had fair to poor outcome. Mean final DASH score of 23.99 was recorded among the study group. Maximum number of patients had no complication, complication like superficial infection were reported among few patients. Despite these complication the overall functional result was good; suggesting that open reduction and internal fixation with limited contact dynamic compression plate (LC -DCP) is an effective treatment modality in these fractures. Conclusion: Open reduction and internal fixation with limited contact dynamic compression plate (LC-DCP) is an effective method of treatment for AO type A3, B3 and type C both bone forearm fracture. This implant is particularly helpful in osteoporotic bones.

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

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.

In Vivo Three-Dimensional Analysis of Malunited Forearm Diaphyseal Fractures with Forearm Rotational Restriction.

The aim of this study was to clarify the mechanisms of rotational restriction in malunited forearm diaphyseal fractures. We retrospectively analyzed the cases of 18 patients with malunited forearm diaphyseal fractures and rotational restriction. All patients underwent bilateral computed tomography (CT) of the forearm in maximum supination, pronation, and neutral positions. From these images, we created 3-dimensional (3-D) bone surface models. We quantified the 3-D deformities, identified instances of osseous impingement between the radius and the ulna during forearm rotation, calculated the path length of the central band (CB) of the interosseous membrane, and measured forearm range of motion. Sixteen patients had extension deformity of the radius (the RE group) and 2 had flexion deformity (the RF group). In the RE group, extension deformity of the radius and valgus deformity of the ulna had significant negative correlation with pronation range of motion (R = -0.50, p = 0.046) and supination range of motion (R = -0.63, p = 0.027), respectively. Osseous impingement was mainly observed during pronation (15 of 16 patients). The CB path with the largest changes in length originated from the distal CB attachment area of the radius and ran toward the proximal area of the ulna (the transverse CB). The transverse CB significantly increased in length in supination compared with that in pronation (p < 0.001). Therefore, tightness of the transverse CB appeared to cause supination restriction in the RE group. In the RF group, osseous impingement caused supination restriction. The greatest increases in the transverse CB length were observed in pronation in the RF group, which appeared to cause pronation restriction. In the RE group, pronation restriction was associated with osseous impingement that was due to extension deformity of the radius, and supination restriction was associated with CB tightness that was due to valgus deformity of the ulna. In the RF group, our results suggested that pronation restriction was caused by CB tightness and that supination restriction was caused by osseous impingement. Three-dimensional corrective osteotomy for extension deformity of the radius in malunited forearm diaphyseal fractures would improve rotational restriction by relieving osseous impingement during pronation and CB tightness during supination.

A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures

IntroductionThe purpose of this study was to compare both bone diaphyseal forearm fractures in adolescent patients treated with plate fixation to patients treated with intramedullary fixation to identify differences in complications and outcomes. Materials & methodsA retrospective study was performed on all adolescent patients with age between 10 and16 year and treated with intramedullary fixation or plate fixation for a diaphyseal both bone forearm fracture between 2005 and 2014. Demographic information and clinical data was collected. Radiographs were reviewed to evaluate post-operative radial bow magnitude and location, time to union, and residual angulation. Complications were graded using the modified Clavien-Dindo Classification system. ResultsA total of 102 patients met the inclusion criteria. Of these, 32 were treated with plate fixation and 70 with intramedullary fixation. The intramedullary nail group had 55% of complications classified as major. There were no major complications in the plate fixation group (P = 0.1). The radial bow was significantly more distal and smaller in magnitude in the intramedullary fixation group (P < 0.01). Of the patients who underwent intramedullary fixation, 76% required an open reduction of at least one forearm bone. There was increased time to radiographic union in patients treated with intramedullary fixation when compared to those treated with plates, 68 days versus 58 days (P = 0.03). A second operation was necessary for 91% of patients treated with intramedullary fixation compared to only 3% of patients treated with a plate (P < 0.01). ConclusionDiaphyseal forearm fractures in adolescent patients remain challenging injuries to treat. Forearm bony anatomy is not completely restored with intramedullary fixation. Results suggested an association towards increased complication rates and complication severity with intramedullary fixation. Level of evidenceLevel 3 retrospective comparative study

Conservative vs. surgical intervention in diaphyseal forearm fractures in age group 1 to 15 years: A prospective study

Pediatric diaphyseal breaks of the radius and ulna, regularly alluded to as both bone lower arm fractures, are the third most basic fractures in the paediatric populace and record for 13-40% of all pediatric fractures.1, 2. More than 40% of young ladies and more than half of young men manage no less than one fracture amid youth and adolescence, (3) with distal lower arm breaks being among the most widely recognized, representing up to 33% of all pediatric fractures. (3) Thus, the role of a childhood distal forearm fracture, in particular, on fracture risk later in life, would have practical clinical applications. Given the magnificent rebuilding potential of youthful patients, certain examinations have concluded that even with 100% uprooting of the radius and ulna closed reduction is an amazing treatment decision for youngsters 9 years of age and younger [14, 15]. Nonetheless, the correct measure of angulation, dislodging, and revolution of bone stays questionable in the writing. It is by and large acknowledged that the nearer the fracture is to the distal physis, the more prominent the potential for rebuilding. Moderate management is yet the main line of treatment for pediatric lower arm fractures particularly in youngsters under 10 years of age. By and by if intervention is required whether adaptable nails or open reduction with plating is needed, then both plating and nailing are adequate treatment choices but however it is nailing which provides less invasiveness, Thus this study shows light upon the management choices available with their pros and cons for various forearm fractures.

Factors that predict instability in pediatric diaphyseal both-bone forearm fractures.

The aim of this study was to determine the factors that may predict failure of closed reduction and casting of diaphyseal forearm fractures in children. Demographic and radiographic data of children with closed reduction and casting of these fractures in the emergency department were evaluated. Of 174 patients with adequate follow-up to union, 19 (11%) required a repeat procedure. Risk factors for repeat reduction included translation of 50% or more in any plane, age more than 9 years, complete fracture of the radius, and follow-up angulation of the radius more than 15° on lateral radiographs or of the ulna more than 10° on anteroposterior radiographs.

Single Versus Double Intramedullary Fixation of Paediatric Both Bone Forearm Fractures: Radiological Outcomes.

IntroductionBoth bone diaphyseal forearm fractures are common in children. If the reduction is unstable, intramedullary fixation using elastic intramedullary nails (EIN) is an option. Intramedullary fixation may be either of single (S-EIN) or both (double) bones (D-EIN). Some reports have shown poorer outcomes with S-EIN. Our aim was to critically analyse the radiological features of EIN cases, comparing results for single and both bone fixation.MethodRetrospective review (two years: November 2014–November 2016) of EIN forearm procedures. Radiological reduction of the radius/ ulna (AP/lateral) was measured on theatre fluoroscopy and six week radiographs. The results were categorised by angulation: (i) <10°, (ii) 10–20°, and (iii) >20°.ResultsOf 36 patients (19 boys, 17 girls), 13 had S-EIN (mean age 9.6 years, range 7–14) and 23 had D-EIN (mean age 10 years, range 7–14). In the S-EIN group, two and 11 had the ulna and radius fixed, respectively. Intraoperatively, of the 13 S-EIN patients, nine had <10° angulation of the radius or ulna, two had 10–20°and two had >20°. All 23 D-EIN patients had intraoperative radiology showing <10° angulation of both bones and maintenance of reduction of <10° angulation at six weeks post surgery. However, some S-EIN patients had increased deformation: at six weeks, four patients had 10–20° and three patients >20°. No patient in either group had revisional treatment. Time in cast postoperatively was similar in both groups: S-EIN, 6.15 weeks (4–12) and D-EIN, 5.5 weeks (3–8). Operative time was 64 mins (43–82) and 76 mins (45–86) in S-EIN and D-EIN groups, respectively. No other complications were recorded.ConclusionThough there may be particular reasons for selecting single bone fixation, this series shows a propensity to increased angulation of fractures fixed by S-EIN (7/13 in this group). We advise caution in the use of single bone fixation for both bone forearm fractures.

A prospective comparative study of internal fixation of diaphyseal forearm fractures with LCP and DCP in above 50 year age group

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In orthopedic practice forearm bone fracture is commonly encountered fracture. Forearm plays a vital role in day to day activities without which a person is unable to perform his role in his own life. It has been estimated that around 31% of the total fractures of the upper limb are of forearm fractures. The objective of the study was to study and compare internal fixation of diaphyseal forearm fractures with LCP and DCP in above 50 year age group&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Present study was hospital based study. This was a prospective study. A total of 50 patients with fracture of both bones in the forearm were included in the present study. They were divided randomly as 25 patients in each group. They were followed for about eight months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Both the groups in the present study were found to be comparable in terms of age, sex, mode of injury, type of injury and level of fracture. It took only 13.83 weeks for radiological union in LCP group and it took a longer in DCP group of 15.33 weeks. This difference was found to be statistically significant. Overall functional results were almost same in both the groups. Excellent in 36 cases (19 in LCP, 17 in DCP), Good in 10 cases (4 in LCP, 6 in DCP), fair in 4 cases (2 in each group).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It has been concluded from the present study that union of fracture after LCP had taken significantly lesser time as compared to the DCP technique. Hence especially in persons above 50 years, LCP should be used.&lt;/p&gt;

A study of efficacy of locking versus dynamic compression plates for diaphyseal forearm fractures

Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs 1, 4. Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation. 2, 3 various treatment modalities were introduced from time to time and each of them had some edge over the previous one. The forearm represents the critical anatomic unit of upper limb, permitting the effector organ of the upper limb, the hand, to perform multiaxial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional outcome, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. 3, 5, 7 The number of forearm fractures is increasing faster than the predicted rate due to increasing number of road traffic accidents, increased incidence of violence, rapid industrialization, and various sports activities. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome 4, 6, 7. compression techniques have a lower incidence of non-union and are found to hasten rehabilitation, with less joint stiffness.the various modalities of plating have developed each has edge over the other. there are very less studies on indian population this study has taken up to analyse the outcome between two most commonly used plates in forearm shaft fracture treatment i.e DCP (dynamic compression plate) and LCP (locking compression plate). Aims and Objectives of The Study: 1) To study and compare the functional and radiological outcome after surgical intervention by using and open reduction and internal fixation with dynamic compression plating vs locking compression plate in the treatment of closed diaphyseal fractures of forearm. 2) To study and compare the complications associated with these two modalities of the treatment. Materials And Methods: About 60 patients with both bone forearm fractures treated with LCP or DCP in RLJ hospital attached to Sri Devaraj Urs Medical College between maech 2013 to june 2017, will be taken up for the study after obtaining the informed consent. This is a retrospective study with follow up period of 6 months minimum. The functional outcome was assesed according to Anderson scoring system which included evaluation of the movements and the radiological union. Conclusions: Statistically, both LCP and DCP have similar outcomes in the treatment of diaphyseal fractures of both bones forearm. Whereas, LCP group had a faster recovery as compared to DCP group. Thus, we conclude that both LCP and DCP have similar results for the diaphyseal fractures.

Treatment of forearm fractures in children and adolescents with titanium elastic nails (Tens): A prospective study

Paediatric forearm fractures are generally treated nonoperatively by close reduction and casting. Recently there has been trend on intramedullary nailing of diaphyseal forearm fractures for unstable fracture pattern to impove clinical outcomes. In our study we evaluated the rate of fracture union, functional outcome and complications in forearm fractures of children and adolescents treated with titanium elastic intramedullary nails. All cases achieved union within 16 weeks and excellent functional outcome after surgical management without significant complications. Intramedullary nailing with Titanium elastic nails is a feasible and effective method of treatment for unstable diaphyseal fractures of forearm in children and adolescents.

Diaphyseal forearm fractures, 20 years after surgical treatment. Is there still an indication for percutaneous fixation?

ObjectiveThis is a retrospective study of 98 diaphyseal forearm fractures in adults, treated by a percutaneous technique with intramedullar Kirchner wires. Materials and methodWe reviewed 64 patients with 98 forearm fractures with a radiographic follow-up, assessing the presence of pseudoarthrosis or delayed bone union and evaluating functional outcomes with the Anderson and the Disability of the Arm, Shoulder and Hand scale. ResultsClinical and radiological bone union was achieved in an average of 12 weeks. We obtained 77% of excellent and good results following Anderson's scale. There were 4 cases of pseudoarthrosis and 6 cases of delayed bone union. ConclusionThis surgical technique provides several advantages, such as a low incidence of complications and a total absence of infections, refractures and iatrogenic neurovascular injuries. It allows a lower hospital stay and a shortening of the surgery time compared with other techniques such as plates and intramedullary nails, that have similar results, in terms of bone union and functional outcomes, as we have verified from the published literature.

Intramedullary Nailing of Both Bone Forearm Fractures in Children by Rush Nails and Titanium Elastic Nails

INTRODUCTION: Forearm fractures are common upper limb injuries among children and usually treated nonoperatively. Failure of nonoperative treatment, open injuries and multiple fractures are the indications for surgery in paediatric both bone forearm fractures. Intramedullary (IM) nailing is considered as minimally invasive procedure with excellent to fair outcomes but it is not free of complications. We reviewed the results and compared the outcomes of IM fixation by Rush nails with titanium elastic nails (TENs), to understand the risks and complications associated with this procedures. MATERIAL AND METHODS: We performed a retrospective review of all paediatric patients treated for diaphyseal forearm fractures from January 2011 to December 2015. Complications were classified according to modified Clavien-Dindo complication classification system. Outcomes were graded depending upon complication grade along with range of motion of forearm. RESULTS: There was no statistically significant difference for mean time to fracture union between the Rush nailing (10.56 weeks ) group and TENs nailing group (9.85weeks) (P = 0.43). There was no statistically significant difference in outcomes between Rush nailing and TENs nailing group p=0.65. In Rush nailing group outcomes were excellent in 16 (64%), good in 7(28%), fair in 2( 8%) patients and no poor outcome were noted. In TENs nailing group outcomes were excellent in 11 (55%) , good in 6 (30%), fair in 3 (15%) patients and no poor outcomes were noted. CONCLUSION: Fixation of pediatric forearm fractures by intramedullary Rush nails and titanium elastic nails (TENs) are minimally invasive procedures and results are excellent to fair with acceptable complication rates. Since Rush nails are easily available and affordable in developing countries like ours we can prefer Rush nails for intramedullary fixation of paediatric forearm fracture when indicated. Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 10-15

Fracturas diafisarias de antebrazo, 20 años después. ¿Está indicada la osteosíntesis percutánea?

ObjectiveThis is a retrospective study of 98 diaphyseal forearm fractures in adults, treated by a percutaneous technique with intramedullar Kirchner wires. Materials and methodWe reviewed 64 patients with 98 forearm fractures with a radiographic follow-up, assessing the presence of pseudarthrosis or delayed bone union and evaluating functional outcomes with the Anderson and the Disability of the Arm, Shoulder and Hand scale. ResultsClinical and radiological bone union was achieved in an average of 12 weeks. We obtained 77% of excellent and good results following Anderson's scale. There were 4 cases of pseudarthrosis and 6 cases of delayed bone union. ConclusionThis surgical technique provides several advantages, such as a low incidence of complications and a total absence of infections, refractures and iatrogenic neurovascular injuries. It allows a lower hospital stay and a shortening of the surgery time compared with other techniques such as plates and intramedullary nails, that have similar results, in terms of bone union and functional outcomes, as we have verified from the published literature.

Utility of the Three-Point Index in the determination of reduction loss during the conservative treatment of pediatric forearm mid-third fractures.

Forearm fractures constitute approximately 40% of all pediatric fractures. Generally, in conservative treatment,a plaster cast is applied with the elbow in 90° flexion. Success of the treatment depends on theprevention of the reduction in the correct position and suitable duration of the plaster cast. Failure, or the risk of angulation within the cast, is associated with movement within the cast. The aim of this study was to evaluate the applicability of the Cast Index (CI) and Three-Point Index (TPI) measurements, which indicate the loss of reduction, in pediatric mid-third forearm fractures. The hypothesis of the study was that as edema decreases and deformity of the plaster cast occurs after fracture reduction, TPI and CI should be examined during follow-up, as they indicate shifting due to movement within the plaster cast. This retrospective study included a total of 48 patients, who were treated with closed reduction and long-arm plaster cast for a mid-third forearm diaphyseal fracture at our Emergency Polyclinic between March and September 2014. The mean age of the patients was 8.15±3.19 years (range, 5-14 years). Patients were excluded from the study if they had isolated radial or ulnar fracture, open fractures, concomitant fracture or systemic disease (bone metabolism disease, etc), and <10° fracture angulation in the ulna and radius on the initial radiograph and if they did not followup. TPI and CI values were calculated on anterioposterior (AP) and lateral radiographs in the Picture Archiving Communication Systems. In the AP plane, compared with TPI values after reduction, statistically significant increases were observed in TPI values 10 days after reduction (p<0.01). However, no significant difference was observed between those with and without reduction loss in TPI values in the AP plane (p>0.05). Although there was a statistically significant increase in TPI values 15 daysafter reduction compared with the values immediately after reduction, a significant difference between those with and without reduction loss was observed only on lateral TPI. In cases of pediatric forearm diaphyseal fracture, ulnar TPI examined in the lateral plane can be used in monitoring the fracture in a plaster cast applied after the reduction.