Fixation Of Diaphyseal Fractures Research Articles

Mechanically compliant locking plates for diaphyseal fracture fixation: A biomechanical study.

Axial micromotion between bone fragments can stimulate callus formation and fracture healing. In this study, we propose a novel mechanically compliant locking plate which achieves up to 0.6 mm of interfragmentary motion as flexures machined into the plate elastically deflect under physiological load. We investigated the biomechanical performance of three compliant plate variations in comparison to rigid control plates with small and large working lengths in a comminuted bridge plating scenario using humeral diaphysis surrogates. Under static axial loading, average interfragmentary motion was 6 times larger at 100 N (0.38 vs. 0.05 mm) and nearly three times larger at 350 N (0.58 vs. 0.2 mm) for compliant plates than rigid plates, respectively. Compliant plates delivered between 2.5 and 3.4 times more symmetric interfragmentary motion than rigid plates (p < 0.01). The bi-phasic stiffness of compliant pates provided 74%-96% lower initial axial stiffness up to approximately 100 N (p < 0.01), after which compliant plate stiffness was similar to rigid plates with increased working length (p > 0.3). The strength to failure of compliant plates under dynamic loading was on average 48%-55% lower than rigid plate groups (p < 0.01); however, all plates survived cyclic fatigue loading of 100,000 cycles at 350 N. This work characterizes the improvement in interfragmentary motion and the reduction in strength to failure of compliant plates compared to control rigid plates. Compliant plates may offer potential in comminuted fracture healing due to their ability to deliver symmetric interfragmentary motion into the range known to stimulate callus formation while surviving moderate fatigue loading with no signs of failure.

Surgical methods of treatment for tibial diaphyseal fractures

Background. Bone fractures are a public health concern. In recent years, there has been an upward trend in body weight of people of all age groups. Obesity has long been thought to help protect against fractures, but recent studies have shown that for every 5 cm increase in waist circumference, the risk of any fracture is 3 % higher. The purpose: according to the meta-analysis of modern medical literature, to determine the main directions of surgical treatment for long bone fractures, their advantages, and disadvantages, including in overweight patients, the features of diaphyseal fracture fixation in overweight patients. Materials and methods. A meta-analysis of special literature from scientific databases was conducted: Cochrane Library, Scopus, National Library of Medicine — National Institutes of Health, ReLAB-HS Rehabilitation Resources Repository. One hundred and thirty articles were analyzed, from them 31 were selected, which, in our opinion, reflect the purpose of the study. Results. All methods of surgical fixation of fractures have their advantages and disadvantages. The frequency of nonunions caused by intramedullary fixation of the femoral shaft can reach 10 %, and varus/valgus and rotational deformities and shortening can also be observed. But the use of locking screws prevents the occurrence of most complications. When fixing the fractures with plates, the main complications are related to superficial and deep infections, which were more often observed in overweight patients. The analysis demonstrated that in overweight and obese patients, the main complicating factor is not the method for fixing the fracture zone, but factors related to the health of the patient himself. So, despite the fact that the results of treatment of fractures in patients with normal weight and obesity did not have a statistically significant difference, an increase in cardiovascular complications, exacerbation of chronic respiratory diseases was observed. Moreover, it is the presence of concomitant diseases that often makes surgical intervention impossible. Conclusions. There is a large amount of research on surgical methods of fixing tibial diaphyseal fractures, but data on the choice of fixation method in overweight and obese patients as a separate approach were not found. There are data on complicating factors of excess weight in the treatment of fractures and surgical interventions. Systematic studies related specifically to the algorithm for choosing the method of fracture fixation and complications have also not been found.

Mechanical behaviors of titanium, nickel–titanium, and stainless elastic intramedullary nail in fixation of tibial diaphyseal fractures

IntroductionElastic nails have been widely used in the diaphyseal fracture fixation of long bones in adolescents. However, high complication rates have been reported in cases involving weights exceeding 55 kg. The existing nails are fabricated with different metals in clinical settings; however, the effect of the materials on the mechanical responses of the fractured bone remains unclear. Hence, the present study is conducted to compare the mechanical responses of typically used metals, namely titanium, stainless, and nickel–titanium, for elastic nails in the fixation of tibial diaphyseal fractures. Material and methodsA sawbone tube is used to determine the contact force, which is developed after constraining the nail inside the narrow canal using different nail materials. Furthermore, a finite element (FE) model of the tibial diaphyseal fracture is developed to predict the fracture gap deformation based on different nail materials under axial compression and bending loads. The push-out force in the FE simulation is compared with that of a case without an end cap. ResultsIn the sawbone tube, the results indicate that the contact force developed by the titanium nail is significantly higher than those developed by stainless and nickel–titanium nails. The contact forces developed by the titanium, stainless steel, and nickel– titanium nails are 385 (SD 34), 358 (SD 49), and 258 (SD 42) N, respectively. In the FE simulation, the titanium nail yields the highest push-out force when an end cap is not used, and the push-out forces in axial compression are 201, 183, and 87 N in the titanium, stainless, and nickel–titanium nails under axial compression, respectively. By contrast, the stainless nail yields the smallest gap deformation when an end cap is used. ConclusionResults of the present study show that the end cap is an important factor affecting the mechanical responses of nails fabricated using different materials. Titanium nails are preferred when an end cap is not used, whereas stainless nails are preferred when an end cap is used.

Investigation of lattice infill parameters for additively manufactured bone fracture plates to reduce stress shielding

BackgroundStress shielding is a detrimental phenomenon caused by the stiffness mismatch between metallic bone plates and bone tissue, which can hamper fracture healing. Additively manufactured plates can decrease plate stiffness and alleviate the stress shielding effect. MethodsRectilinear lattice plates with varying cell sizes, wall thicknesses, and orientations are computationally generated. Finite element analysis is used to calculate the four-point bending stiffness and strength of the plates. The mechanical behaviors of three different lattice plates are also simulated under a simple diaphyseal fracture fixation scenario. ResultsThe study shows that with different combinations of lattice infill parameters, plates with up to 68% decrease in stiffness compared to the 100% infill plate can be created. Moreover, in the fixation simulations, the least stiff lattice plate displays 53% more average stress distribution at the healing callus region compared to the 100% infill plate. ConclusionsUsing computational techniques, it has been demonstrated that additively manufactured stiffness-reduced bone plates can successfully address stress shielding with the strategic modulation of lattice infill parameters. Lattice plates with design versatility have the potential for use in various fracture fixation scenarios.

Spontaneous distal migration of Kuntscher intramedullary nail into leg from malunited distal femur fracture: A rare case report

Kuntscher cloverleaf nail, also called as K-nail, is an intramedullary nail (IMN), made from stainless steel with a slot along the longitudinal axis. It is used in fixation of short oblique, simple transverse, Winquist- I and II comminuted fractures of femur. This was a case in which the Kuntscher nail spontaneously migrated distally, and was extruded completely from the femur into the leg along the posterior aspect till the ankle with the most probable cause being malunion of an oblique distal femur fracture. There were no recent reports on this type of distal migration till date. A 72-year-old male, who is working as farmer in a rural area, came to our institution with pain and swelling on &amp; off around the left ankle for last two months during May 2022. Local examination of left lower limb revealed that there was swelling around the left ankle. There was a palpable hard metallic object posterior to the left medial malleolus. There is a single well healed surgical scar of length 10 cms on the lateral aspect of left distal thigh. Radiological workup was done accordingly. Final diagnosis was – Postoperative spontaneous migration of Kuntscher nail into the leg from a malunited fracture of lower 1/3 of left femur. Treatment plan was implant removal. After implant removal, the patient was discharged in a stable condition and follow-up till 6 months revealed no complaints around the ankle or knee joints. Distal migration of K-nail across the knee joint after femur diaphyseal fracture fixation is a rare and preventable complication. It is recommended that K-nails should be routinely removed as soon as radiological union and consolidation of the fracture is confirmed, to avoid rare postoperative complication of distal migration of the K-nail.

Comparative study of internal fixation of diaphyseal fractures of both bones of the forearm in adults between intramedullary nailing and plate osteosynthesis

Background: Diaphyseal forearm fracture is one of the most commonly encountered fractures of the upper extremity. The literatures comparing the outcome of plate fixation and intramedullary nailing in adults are scarce and therefore the consensus on superiority of one over the other is lacking. This study was undertaken to compare the outcome of these operative techniques in adults with diaphyseal fracture of both bone forearm. Aims and Objectives: This study was undertaken to compare the outcome of plate fixation and intramedullary nailing in adults with diaphyseal fracture of both bone forearm. Materials and Methods: Patients of 18–70 years of age, with diaphyseal fractures of both bones of the forearm of &lt;21 days old, were recruited. Patients were randomly allocated to two treatment groups: intramedullary nailing and plate osteosynthesis. Patients were followed up at 4th week, 12th week, and 24th week post-operative period. Functional outcome was measured at the end of 24th week based on the Clinical and Radiological parameters by Anderson et al., Score, Grace-Eversman Score, and Disabilities of the Arm, Shoulder and Hand (DASH) Score. Results: This study comprised of 40 cases (n=40) who completed the follow-up period of 24 weeks. Most of the patients treated with plate (80%) demonstrated excellent outcome as per Anderson et al., score while the outcome was unsatisfactory in 50% of those treated with nails. About 90% of the patients of plate group had excellent result in contrast to 50% in case of nail group following Grace Eversman criteria. Considering DASH score, the former group showed mostly excellent (40%) and good (45%) outcome while the latter exhibited mostly fair (55%) and good (30%) result. Conclusion: It may be stated that plate osteosynthesis is a better option in the treatment of diaphyseal fracture of both bones forearm in adults.

Comparison of five methods for locked-plate fixation of complex diaphyseal fractures

BackgroundPeri-prosthetic fractures (PPFs) are steadily rising in number due to population ageing and increased performance of joint replacement procedures. Although PPFs without implant loosening are usually managed by internal fixation, no consensus exists regarding the optimal construct. The primary objective of this study was to compare five constructs, and the secondary objective was to compare sub-groups of mono-cortical screw constructs, with the goal of identifying the method most appropriate for diaphyseal fracture fixation when prosthetic material is present within the intra-medullary canal. HypothesisThe primary hypothesis was that fixation using bi-cortical screws, i.e., the current reference standard, was superior over other fixation methods. The secondary hypothesis was that adding double cerclage to mono-cortical screw fixation provided the greatest mechanical strength. Materials and methodsSynthetic osteoporotic bone was used to compare five methods for locking-screw fixation of a femoral diaphyseal plate. One method involved bi-cortical screws and four methods mono-cortical screws, with no cerclage wire, a single cerclage wire on either side positioned near or at a distance from the fracture, and two cerclage wires on both sides of the fracture. A complex fracture was simulated by creating a 2-cm diaphyseal gap. Load-to-failure was determined by applying compression loading along the anatomical axis of the femur. ResultsBi-cortical screw fixation provided greater mechanical strength than did three of the four mono-cortical screw constructs. The exception was the mono-cortical-screw and double-cerclage construct, for which no significant difference was found compared to bi-cortical screw fixation. Thus, mono-cortical screw fixation with double cerclage may be the best alternative when presence of an implant in the intra-medullary canal precludes bi-cortical screw fixation. ConclusionThe findings from this study have clear implications for clinical practice. The study hypotheses were partly confirmed. The absence of a significant difference between the reference-standard bi-cortical screw fixation method and mono-cortical screw fixation with double cerclage, combined with the results regarding the secondary objective, suggest that mono-cortical screws plus double cerclage deserve preference in patients with an intra-medullary implant. Clinical studies are needed to assess the results of this bench study. Level of evidenceIV, bench study.

Comparing titanium elastic nailing and plate osteosynthesis in treating both bone diaphyseal fractures of forearm in children

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The present study aimed to compare the outcome of fixation of diaphyseal fractures of both bones of forearm using plate osteosynthesis (PO) and titanium elastic nail (TEN).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This comparative non-randomized clinical trial was done on children aged 5 to 15 years, with diaphyseal fractures of both bone forearm fractures, operated and managed at the department of orthopedics, Assam Medical College and Hospital, Dibrugarh. Intra- and post-operative findings were compared between PO and TEN group patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Duration of hospital stay was significantly lower in patients in the TEN group (44.75±6.38 minutes) as compared to those in the PO group (69.71±5.91 minutes), p value &amp;lt;0.01. Similarly, duration of hospital stay was significantly lower in patients in the TEN group (5.01±0.67 days) as compared to those in the PO group (8.32±1.44 days), p value &amp;lt;0.05. Based on price criteria, 80% of the patients in the PO group and 85% in TEN group had excellent functional outcome. Radiological union time, maximum radial bow and location of maximal radial bow were found to be statistically similar in the two groups. Complication rate was similar in the two study groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Based on the results of the present study, we conclude that both PO and TEN are be safely performed in children with diaphyseal both bone forearm fractures. With comparable functional and radiological outcomes, future studies are required before one technique can be recommended over the other.&lt;/p&gt;

Pulsed electromagnetic fields after intramedullary nailing of tibial fractures: a case control study.

To compare clinical and functional outcomes of two groups of patients undergoing reduction and nailing fixation for diaphyseal fractures of the tibia with (PEMF group) and without (control group) post-operative pulsed electromagnetic field (PEMF) application. This is a retrospective study on 50 patients (mean age 43.3years, 28 males and 22 females) with diaphyseal tibial fractures managed between 2017 and 2019. Twenty-five patients underwent reduction, nailing fixation, and PEMF application post-operatively (PEMF group) and 25 patients underwent nailing fixation. Radiographic imaging assessment was performed every month until fracture healing had been evident. Use of analgesics, fracture healing time, post-operative lower limb alignment, and post-operative complications were recorded. Patients were asked about return to preinjury activity. All patients were assessed at 3months and at an average follow-up of 13months. The VAS scale and Johner-Wruhs criteria were used for pain assessment and functional recovery, respectively. Comparing groups, VAS values were significantly lower in the PEMF group at threemonths and comparable at oneyear. The patients in the PEMF group took an average of 4.1months to resume their preinjury activities, and control patients took an average of 5.3months (P < 0.0001). According to the Johner-Wruhs score, the effective rate was 100% (25/25) in the PEMF group and 92% (23/25) in the control group (P = 0.14). PEMF application after intramedullary nailing is safe and reduces post-operative pain, use of analgesics, and the time of healing fracture. At oneyear, there is no difference in outcome measures, regardless of PEMF application.

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra-articular diaphyseal humeral fractures.

The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: themodified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. &#x0D; Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. &#x0D; Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. &#x0D; Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

Functional outcome of locking compression plating in diaphyseal fractures of radius and ulna

Background & Objectives: Forearm fractures are regarded as articular fractures as slight deviations in spatial orientation of the radius & ulna will significantly decrease the forearm’s rotational range thus disturbing positioning & functioning of the hand. Conservatively done reduction of these fractures results in a poor functional outcome. Hence perfect reduction is essential in maintaining the rotation which is achieved by open reduction & internal fixation with plate & screws. The present study is undertaken to learn the techniques assess the advantages, functional outcome and complication of the new method of internal fixation of diaphyseal fractures of radius & ulna.Materials & Methods: A prospective study involving 20 cases was carried out from September 2015 to September 2017 at Bapuji Hospital and Chigateri General Hospital attached to JJM Medical College, Davangere. These cases involving fracture both bone forearm was treated with open reduction & internal fixation using Locking Compression Plating. Functional outcome was assessed using Anderson et al. criteria scoring system (1975).Results: In this study, majority of the patients were males, middle aged, with road traffic accidents being the commonest mode of injury, involving middle third of both bones of forearm. Majority of our cases had fracture union within 14 weeks with no cases of failure or non-union and most of the patients returned to their routine activities within 16 weeks of surgery. There was no major complication in our study. Excellent or full range of mobility of elbow and wrist joints was present in 15 patients (75%) and 5 (25%) patients had good range of movements.Conclusion: The open reduction and internal fixation with LCP of forearm fractures produce excellent results, the advantage being early mobilization, early union but the complication, duration of surgery and surgical techniques remains unchanged.

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.

Study of titanium elastic nailing system in long bone fractures in children at Pravara rural hospital, Loni

Globally, traumatic injuries of long bones shaft fractures in children are the most leading causes of fractures in children. Now a days the use of elastic stable intra-medullary nails has dramatically increased with the introduction of a variety of nails for paediatric fractures [1]. The Titanium Elastic Nail (TEN) is intended for fixation of diaphyseal fractures of long bones where the medullary canal is narrow or flexibility of the implant is paramount. The aim of this study of biological, minimally invasive fracture treatment is to achieve a level of reduction and stabilization that is appropriate to the age of the child. The biomechanical principal of the Titanium elastic nailing is based on the symmetrical bracing action of two elastic nails inserted into the metaphysis, each of which bears against the inner bone at three points. This was a prospective longitudinal study done over a period of one year in children between 5-14 yrs age groups. The complication rates associated with Titanium elastic nailing have been reported to be minimal.

Technical considerations to avoid delayed and non-union

For many years intramedullary nails have been a well accepted and successful method of diaphyseal fracture fixation. However, delayed and non unions with this technique do still occur and are associated with significant patient morbidity. The reason for this can be multi-factorial. We discuss a number of technical considerations to maximise fracture reduction, fracture stability and fracture vascularity in order to achieve bony union.

Intramedullary nail fixation of non-traditional fractures: Clavicle, forearm, fibula

Locked intramedullary fixation is a well-established technique for managing long-bone fractures. While intramedullary nail fixation of diaphyseal fractures in the femur, tibia, and humerus is well established, the same is not true for other fractures. Surgical fixations of clavicle, forearm and ankle are traditionally treated with plate and screw fixation. In some cases, fixation with an intramedullary device is possible, and may be advantageous. However, there is however a concern regarding a lack of rotational stability and fracture shortening. While new generation of locked intramedullary devices for fractures of clavicle, forearm and fibula are recently available, the outcomes are not as reliable as fixation with plates and screws. Further research in this area is warranted with high quality comparative studies, to investigate the outcomes and indication of these fractures treated with intramedullary nail devices compared to intramedullary nail fixation.

Surgical management of pectoral limb long bone fractures in dogs: Clinical and Radiographical studies

This study was carried out on 27 adult male mongrel dogs. These dogs were subjected to an artificialinduction of diaphyseal fractures including the long bones of the pectoral limb (humerus, radius & ulnaand metacarpal). The induced fractures were managed surgically via different fixation techniques (boneplating, intramedullary bone pinning (IMP) and unilateral transkeletal fixation (TSF) as well asapplication of plaster of Paris bandages). The obtained results were evaluated clinically andradiographically. The present study aimed to record the clinical signs and radiographic improvementand post-operative complications of such techniques and additional aim was to suggest the best methodfor fixation of diaphyseal fractures of long bone of pectoral limb

English

BACKGROUND: Plate osteosynthesis is the most commonly used technique for the treatment of diaphyseal forearm fractures in adults. However, application of a plate can disrupt the periosteal blood supply and necessitates skin incision that may be unsightly, and there is a risk of refracture if the implant is removed. The purpose of this study was to assess the early results of the use of closed intramedullary nail to stabilize displace diaphyseal fractures of both bones forearm. 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 nailing. 2. To compare the functional results of the two groups treated with plate osteosynthesis and closed intramedullary nailing. 3. To review the literature on the treatment of diaphyseal fractures of forearm bones. METHODS: From September 2006 to October 2008 in the Department of Orthopaedics and Traumatology, Gandhi medical college and associated Hamidia Hospital, Bhopal, total of 38 patients of both bones forearm fractures were treated. Eighteen (18) patients with were treated with plate osteosynthesis and 20 patients with closed intramedullary nailing using the square nails. Total 31 patients were available for the follow up. Average follows up in plate osteosynthesis group was 14.1 months and in closed intramedullary nailing group was 15 months, with range from 12 months to 21 months. Functional results were assessed by Anderson et al criteria (1975). RESULTS: Average surgery time in plate osteosynthesis group was 68 minutes, and in closed nailing group was 43 minutes. In plate osteosynthesis group radius showed union in 14 (93.2%) patients and ulna in 13 (86.8%) of patients, in closed nailing group both radius and ulna resulted in 100% union rate. In plate osteosynthesis group there was 1 deep infection, 1 implant failure, and 3 nonunion. Functional results in plate osteosynthesis group were excellent in 12 (80%) of patient, satisfactory in 1(6.6%), failure in 2(13.2%). There was no unsatisfactory result in this group. In closed nailing group result were excellent in 11(68.7%), satisfactory in 4(24.8%), unsatisfactory in 1(6.2%) and no failure. CONCLUSIONS: Our experience indicates that the advantage of closed intramedullary nailing for fractures of both bones forearm are that it is technically straightforward, it allows high rate of osseous union, and it requires less surgical exposure and operative time, less risk of infection than does 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 and radiation hazard to patient and surgeon. 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. KEYWORD: forearm nailing, forearm plating.

HYBRID PLATING SHOWS EQUIVALENT BIOMECHANICAL BENDING STRENGTH TO UNICORTICAL LOCKED PLATING

Locking unicortical screw fixation of diaphyseal fractures may be clinically necessary due to internal constructs or prosthetic implants. The biomechanical effects of substituting one or more bicortical nonlocking screws to create a "hybrid" construct are unknown. Use of an initial nonlocking screw may be clinically desirable for creating initial plate-to-bone fixation prior to locking. A validated transverse fracture model was used with eighteen synthetic humerus models. Plate and screw fixation was performed in three treatment groups (n = 6): Unicortical locking screws only, fixation with two unicortical locking screws and one bicortical nonlocking screw on either side of the fracture and fixation with one unicortical locking screw and two bicortical locking screws on either side of the fracture. Displacement and gap strain measurements were made with a cyclic 4-point bending test. No significant differences were noted for construct stiffness or gap micromotion among the three groups on cyclic testing. Measurements at 1000, 5000, and 10,000 cycles showed stable fixation of all construct types with no significant changes in stiffness or micromotion. Substitution of one or more bicortical nonlocking screws in a unicortical locked construct does not affect construct stiffness or fracture gap strain. Data proven through controlled laboratory study.

History of Operative Treatment of Forearm Diaphyseal Fractures

Diaphyseal fractures of the forearm have accompanied humanity throughout its history. Nonsurgical techniques dominated the treatment for centuries, and complications including nonunion and malunion were common. The 19th century featured the recognition of distinct injury patterns. With the development of anesthesia and antisepsis, the operative treatment became widespread. In 1878, Heine described fixation of the diaphyseal nonunion of the distal ulna using an intramedullary ivory peg. Parkhill reported on the application of external fixation for forearm fractures in 1897-1898. Hansmann published the case of plate osteosynthesis of an acute fracture of the radius in 1886. In 1913, Schöne published the technique of closed intramedullary fixation of diaphyseal fractures of the forearm using a silver wire. During the first 2 decades of the 20th century, plate osteosynthesis quickly spread across Europe and North America owing to the influence of Lambotte and Lane. After the World War II, plate osteosynthesis became the surgical treatment of choice for forearm diaphyseal fractures.