Bone Forearm Fractures Research Articles

Treatment of both bone forearm fractures with 2.7mm plates: a non-inferiority study.

To determine the effectiveness of 2.7mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5mm fixation. More specifically, to determine if 2.7mm plates are non-inferior to the current standard of 3.5mm plates. Retrospective including patients from 2016-2021. Single institution, level-1 trauma academic medical center. 77 patients met inclusion criteria, 58 patients underwent fixation with 3.5mm plates and 19 underwent fixation with 2.7mm plates. Plate osteosynthesis with either 2.7mm or 3.5mm plate instrumentation. Maintenance of reduction and achievement of fracture union. Among 77 total patients, 19 received 2.7mm plates and 58 received 3.5mm plates. There was no difference in age and BMI between groups, but the 2.7mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7mm and 3.5mm groups. This study challenges the current standard of ORIF using 3.5mm plates for diaphyseal forearm fractures. 2.7mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal. Level III, retrospective cohort study.

Outcomes of Management of Pediatrics Both Forearm Bone Fractures by Using Titanium Elastic Nailing System

Background: Forearm fractures include 25% of all infantile complaints. Forearm fractures account for 30 to 50% of all paediatric fractures and boys were more prone to forearm fractures. Paediatric diaphyseal bone fractures can be treated conventionally through closed manual reduction and casting as the abilities of the paediatric bones to remodel.Titanium Elastic Nails (TENS) is extensively used in children because it is innocuous. The aim of the study to recognize the management of pediatric bone forearm fractures using TENS. Materials and methods: A prospective study was carried out in the Department of Orthopedics, Chattagram Maa-O-Shishu Hospital Medical College from January 2018 to June 2022. A total of 45 patients (n=45) were enrolled in this study. Verbal consent was taken before recruiting the study population. Ethical clearance was taken from the hospital. The information was kept confidential only to be used for the study purpose. Results: Around three-fourths of the study population (34,75.6%) were male and only eleven patients were female and forty-two patients (42,93.3%) had no complaints of strenuous activity. Fractures involved the middle third in the most of the patients (22,48.9%). Closed reduction and internal fixation with titanium elastic nail system were done in forty-four patients (44,97.8%) and the result was excellent in most of the patients (42,93.3%) and satisfactory in three patients (3,6.7%.) Conclusion: Closed reduction and internal fixation with TENS appears to be acceptable treatment preference for the fixation of paediatric bone fractures. It provides exceptional functional consequences in terms of the range of motion and grip strength without chief complications. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 19-23

Vitamin D Levels During Fracture Healing in Children

To evaluate vitamin D levels in children treated with fractures during the healing period. A four-year prospective study, including healthy children treated with diaphyseal fracture of femur or forearm bones. Vitamin D levels were examined four times: at the time of the injury and then one, three, and five months after the injury, together with P1NP, ALP, GGT, and parathormone. In the beginning, patients were blindly divided into two groups, one supplemented with vitamin D3 for the entire follow-up period, the other non-supplemented. Altogether, 107 children underwent examination at the time of their injuries. Of these, 63 were included in the study and examined for the entire follow-up period – 36 supplemented, 27 non-supplemented. At the time of injury, 42 % had a deficit of vitamin D, 36.5 % had insufficiency, only 21.5 % had normal levels. In the children supplemented with cholecalciferol, vitamin D levels increased statistically significantly during the follow-up period (already after 1 month), in contrast with non-supplemented patients, where they did not. When we divided patients according to the initial vitamin D levels (deficit/insufficiency/normal levels) or fracture type (femur/forearm), we also observed significantly better results in supplemented groups. We observed a high prevalence of vitamin D deficit or insufficiency in healthy children at the time of their injuries. Patients supplemented with vitamin D3 had normal levels already after one month and this persisted throughout the follow-up period, in contrast with non-supplemented patients. Therefore, we recommend vitamin D testing and administration for children treated for fractures.

Effectiveness of Hybrid Fixation in the Treatment of Proximal Diaphyseal Both Bone Forearm Fractures in Adolescents.

Pediatric diaphyseal both-bone forearm fractures are one of the most prevalent fractures in orthopedic practice. To assess the anatomical and functional outcomes of hybrid fixation (radius nailing and ulna plating) in treating closed proximal radius and ulna fractures in adolescents. This prospective cohort study was performed on 41 patients between the ages of 10 and 16 years, both sexes, with recent trauma (less than 2 weeks) suffering from closed proximal diaphyseal radius and ulna fractures. Functional outcomes were assessed according to the price score grading criteria, along with the radiological assessment of the union. Regarding Price score grading, 28 (68.29%) cases had an excellent function, 8 (19.51%) had a good function, 3 (7.32%) had a fair function, and 2 (4.88%) cases had a poor function. The mean union time was 7.41 ± 2.65 weeks. Four patients complained of prominent hardware, three cases developed neuropraxia resolved, and two cases had nonunion of both bones and one of them had nail migration. The hybrid fixation technique could be effectively used in the treatment of adolescent proximal both-bone forearm fractures.

Fractures of vertebrae and peripheral bones in patients with rheumatoid arthritis (based on long-term observation)

Introduction. In rheumatoid arthritis (RA), fractures occur on average 2–3 times more often than in the general population. Data on the incidence of vertebral fractures in RA is controversial and depends on the detection method. Aim. To determine the incidence of vertebral and peripheral bone fractures in patients with RA during long-term prospective follow-up. Materials and methods. A prospective multi-year cohort non-interventional study included 120 women with RA (mean age at enrollment 54.3±8.9 years), with a follow-up of 9.5±1.9 years. Initially and then repeatedly, a clinical, laboratory and radiological examination was performed: X-ray morphometry of the spine according to the Genant method, X-ray densitometry of the lumbar spine (LI-LIV) and femoral neck. Results. During the follow-up period, there were 104 low-energy fractures in 64 (53%) patients: 69 (66%) vertebral fractures and 35 (34%) peripheral fractures. Two or more fractures occurred in 25 (39%) subjects. In 30 (25%) patients, 52 fractures occurred repeatedly. Among peripheral fractures, the most frequent localization was fractures of the distal forearm and lower leg bones. Patients with fractures during the follow-up period were also more likely to have fractures before enrollment in the study, had an initially longer duration of RA, a mean daily dose, cumulative dose, and duration of glucocorticoid administration, and a lower bone mineral density in the main parts of the skeleton, determined by densitometry. There was no effect of RA activity on DAS-28, rheumatoid factor positivity, or antibodies to cyclic citrullinated peptide on fractures. Conclusion. More than half of the patients had low-energy fractures during the observation period, the most common being fractures of the vertebrae, distal forearm, and lower leg bones; a high frequency of repeated fractures was reported. The analysis of risk factors showed that a long duration of RA, a mean daily dose, cumulative dose, and prolonged use of glucocorticoids, a history of low-energy fractures, and low bone mineral density were associated with the occurrence of fractures in patients with RA.

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

Background and Objectives: Diaphyseal fractures of the radius and ulna are common in adults and can be managed with various treatment methods. This study aimed to evaluate and compare the functional, radiological, and clinical outcomes of two treatment methods: plating and intramedullary nailing for diaphyseal fractures of both forearm bones in adults. Methods: This prospective cohort study was conducted in Sulaimani City, Kurdistan, involving 40 adult patients (mean age 34.25 years) who sustained primary diaphyseal fractures of the radius and ulna between January 1, 2022, and June 1, 2024. Patients were divided into two groups: Group A, with 20 patients, underwent closed reduction and internal fixation using flexible intramedullary nailing, while Group B, also with 20 patients, underwent open reduction and internal fixation using 3.5 mm dynamic compression plate. Outcomes were assessed using the Modified Grace Eversmann score, with pronation and supination of the forearm compared to the contralateral side. Results: The mean operation time was 81.4 minutes for the plating group, compared to 62.5 minutes for the nailing group. The mean union time was 13.15 and 10.85 weeks for the plating and nailing groups, respectively. In terms of functional outcomes, 27 patients achieved Excellent scores, 9 Good, 3 acceptable, and 1 unacceptable. Complications occurred in 5 patients in the nailing group and 2 in the plating group. Overall, the union and operation times showed a statistically significant difference, with a higher complication rate in the nailing group. Conclusion: Adults with diaphyseal radius and ulna fractures are usually treated with plating. An alternate fixation method for fracture with distinct risk and benefit profile is intramedullary nailing.

Use of cast index and three-point index in paediatric both bone forearm fractures: a prospective study

Introduction The majority of paediatric both bone forearm fractures are treated with manipulative reductions and casting; loss of reduction is one of the most commonly reported complications. We aimed to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures.Materials and methods This prospective observational study was conducted at the Department of Orthopedics, Kalpana Chawala Government Medical College in Karnal to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures. In the present study, 55 patients 16 years old were included irrespective of sex with distal both bones forearm fractures, managed by closed reduction and casting were included.Results Fracture reduction failure was observed in 32.7 % of the patients. Both three-point index and cast index were found to be significantly higher in patients with reduction failure. It was observed that at 2 weeks Area under curve (ROC Curve) for Cast index and Three point index was 0.72 and 0.85 respectively. At 4 weeks, Area under curve for Cast index and Three point index was 0.77 and 0.84 respectively and at 6 weeks 0.74 and 0.86 respectively. Thus, in the present study, CI and 3PI had similar predictability for fracture reduction failure.Discussion There are a few limitations of our study: We could not observe the patients for a longer period of time to know re-modelling in the long term. We did not take in to consideration the severity of fracture, type of anesthesia used (conscious sedation versus General Anesthesia) and the fracture configuration while assessing the outcomes. We also did not collect information about anthropometric parameters like child weight and diameter of the forearm.Conclusion The three-point index and cast index are clinically useful tools to assess the quality of cast molding following closed reduction of pediatric forearm fractures and to predict re-displacement in distal forearm fractures.

Determinants of non-union after standard plate fixation for combined radial and ulnar fractures in adults

Treatment of mid-shaft fractures of both forearm bones in adults typically consists of individual plate fixation of each bone according to AO principles. The primary objective of this multicentre retrospective study was to identify predictive and prognostic factors of failed bone union after internal fixation with a standard plate in adults.130 mid-shaft fractures of both forearms occurred in 92 men and 38 women, who had a mean age of 35.1 years were reviewed; 42 were open: 31 were Gustilo type I, 10 were type II and 1 was type III. All patients underwent ORIF using a direct approach over the supinator crest for the ulnar fracture and using an anterior approach at the level of the radial fracture by dynamic compression plate in 90 cases and a limited-contact dynamic compression plate in 40 cases, all with 3.5 mm diameter screws.The radiographs from all patients were reviewed after a minimum follow-up of 12 months: primary union of both forearm bones occurred in 121 of the 130 cases after a mean of 4.6 months (±2.6). 104 patients were reviewed clinically with a minimum follow-up of 12 months and a mean of 36 months (±21.7). According to Tscherne-Oestern classification, 79 % of patients had a very good outcome, 6 % had a good outcome, 10 % had a fair outcome and 5 % had a poor outcome Non-union occurred in 9 patients (one septic): 4 times at both fracture sites, 4 times at the ulna only and once at the radius only. The mean age was higher in the patients with non-union: 46.4 years versus 34.2 (P = 0.08). Smoking, alcoholism, associated head trauma, presence of pre-operative nerve deficit and open fracture did not appear to be risk factors for non-union. The type of plate used and the number of screws placed on either side of the fracture site had no effect on union.This patient series had a similar non-union rate to the one reported in other published studies, likely because the technical rules were followed. A lack of statistical power probably prevented us from identifying prognostic factors for bone union.

Study of Titanium Elastic Nailing in Forearm Fractures in Elderly Patients

Background: As operative techniques and the quality of implants are improving, surgical management of diaphyseal fractures of forearm bones in elderly patients is gaining widespread acceptance. Titanium elastic nailing system (TENS) provides flexural, axial, translational, and adequate rotational stability. This study aims to analyze the outcomes of the treatment of diaphyseal forearm bone fracture with TENS nail. Methods: Elderly patients with both-bone forearm (BBFA) fractures in diaphysis were evaluated clinically and radiologically and followed for an average of six months. The outcome was assessed using the Grace-Eversmann scoring system. We followed up with all 25 patients and evaluated them every two weeks until the fracture united. Results: After approval of the ethics committee, twenty-five elderly patients with AO type 22A3 and 22B3 fractures of the forearm bone who fulfilled the inclusion and exclusion criteria were taken for the study. The mean age of the participants was 65 years. The average time to bone union was 12 weeks, and the average surgery time was 35 minutes. There was a superficial infection in one case. Most patients had a full range of elbow and wrist movements after the union. Conclusion: The TENS is an acceptable and good tachnique for displaced BBFA diaphyseal fractures in elderly patients. It is easy, cheap, and convenient and gives elastic mobility, promoting a rapid union of fractures and stability, which is ideal for early mobilization. It provides a lower complication rate, shorter surgery time, good cosmetic outcome, and easy implant removal.

Management of Aseptic Both Bone Forearm Diaphyseal Gap Nonunion

Abstract Aseptic nonunions of both bone forearm fractures present significant challenges in treatment, often requiring specialized surgical intervention. This case report provides an overview of the prevalence, etiology, and surgical considerations in managing such nonunions. This case report presents a 51 year old male with both bone forearm diaphyseal nonunion following a road traffic accident, managed with iliac crest and nonvascularized fibular bone grafting. Surgical intervention involved debridement, gap bridging with fibular strut graft, and stabilization with plate. Aseptic both bone forearm nonunions disrupt mechanics, leading to functional impairment. Surgical management aims at maintaining radial length, joint function, and avoiding positive ulnar variance. Treatment involves debridement, alignment correction, bone grafting, and may include vascularized fibular grafting or the Ilizarov method, while nonvascularized fibula strut grafts provide a favorable alternative with low complication rates. The case report demonstrates successful management of aseptic both bone forearm diaphyseal nonunion using nonvascularized fibular strut graft, resulting in excellent functional outcomes without complications. The efficacy and feasibility of this treatment approach in achieving union and restoring forearm function is highlighted.

Single Bone Intramedullary Fixation of the Radius in Pediatric Both Bone Forearm Fractures Using Straight Stainless Steel Kirschner Wire: A Cross-sectional Study on Radiological and Clinical Feature.

We aimed to report radiological and clinical features of single bone intramedullary fixation of the radius in pediatric both bone forearm fractures using straight stainless steel Kirschner (K) wire. Fifty-eight children (42 boys and 16 girls) referred to our hospital with both bone diaphyseal forearm fractures were operated on by using the single bone rigid K-wire intramedullary fixation and mini-open technique. The mean follow-up time was 8.9 months (6-12). The mean age of the patients was 7.4 years (4-12). More than 2/3 of the fractures were in the right hand. Around 63% of the fractures were in the middle third, 28% in the distal third, and 9% in the proximal third. Moreover, 12% were open type I Gustilo-Anderson fractures. The mean time from injury to surgery was two days (1-4), and the mean length of hospital stay was 2.8 days (2-5). The mean duration of surgery was 24.7 minutes (18-38), and the mean follow-up time was 8.9 months (6-12). All fractures united within 4-16 weeks (mean: 7.62). The cast and implant were removed simultaneously as the radiographic fracture union. There was no serious complication. Superficial infection of the pin track and loosening of the pin occurred in three cases (5%), all controlled by antibiotics and timely removal of the pins. Mild restriction of elbow extension (less than 20 degrees) was observed in three cases, which returned to normal at the last follow-up. Limitation of dorsiflexion of the wrist by more than 20° occurred in two patients (35° and 45°), which reverted to 25° and 25°, respectively, at the last follow-up. In both bone forearm fractures in children, open reduction and internal fixation of only the radius with a stainless steel straight Kirschner wire could be a promising method with good results. This retrograde technique of intramedullary fixation is a simple and cost-effective method with minimal complications and acceptable outcomes in children aged 4-12 years.

Functional Outcome of Titanium Elastic Nail Fixation in Diaphyseal Fractures of Forearm in Adolescents

Introduction: This study aims to assess the functional outcomes of Titanium Elastic Nailing System (TENS) fixation for managing diaphyseal forearm fractures in adolescents. Method: The study was a prospective clinical study conducted at B.P. Koirala Institute of Health Sciences Between December 1, 2020, and November 30, 2021. Ethical clearance was obtained from the Institutional Review Committee (Registration Number 305/077/078-IRC). A total of 27 patients who underwent TENS fixation for forearm diaphyseal fractures were included. Patients were followed at 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Radiological and functional outcome evaluations were assessed, including the range of motion, deformity, and time taken for union and active recovery. Collected data were entered in Microsoft Excel and converted to SPSS (Statistical Package for Social Sciences) version 28 for statistical analysis. Results: Among 27 included patients, 66.7% were males, 81.5% were within the age group of 10-13 years, 70.4% fell on outstretched hands, and 66.7% had fractures at the middle third of the forearm. Union was seen in 6 weeks among 29.6%, 12 weeks among 66.6%, and 24 weeks among 3.8%—7.4% developed complications. Conclusion: TENS is an effective fixation method for diaphyseal forearm fractures in adolescents and provides satisfactory functional outcomes. Keywords: Adolescents; Forearm bone fractures; Functional outcome; TENS

Reuse of orthopedic implants in a peri-implant fracture of both forearm bones in an adolescent: A case report

Fractures of both forearm bones in adolescents are common. Many of these fractures are surgically fixed with internal fixation. However, among the complications that can occur are peri-implant fractures, which are somewhat infrequent. They are due mainly to high-energy injuries. Therefore, not much information about them is found in the literature. Reusing implants is not a frequent or well-documented practice, and it is carried out only when the necessary resources are unavailable, particularly in developing countries. We are reporting a 16-year-old male patient who suffered a peri-implant fracture distal to plates that were placed 3 years earlier in both left forearm bones. The material was removed successfully and reused, achieving an adequate reduction and fixation with one dynamic compression plate (DCP) plate for the radius and one reconstruction plate for the ulna. The patient recovered successfully. This case report aimed to understand the lack of resources in a developing country and a possible solution for this problem in this type of scenario.

A PROSPECTIVE STUDY TO ASSESSTHE FUNCTIONAL OUTCOMES OFDIAPHYSEAL BOTH BONE FRACTURESOF THE FOREARM IN ADULTS TREATEDBY OPEN REDUCTION AND INTERNALFIXATION WITH DYANAMICCOMPRESSION PLATE

Indroduction: Forearm fractures can be regarded as articular fractures as slight deviations in the spatial orientation of the radius and ulna will significantly decrease the forearmÂ’s rotational amplitude and thereby impair the positioning and function of the hand. Thus, the management of these fractures deserve special attention as their treatment is not the same as the treatment of other diaphyseal fractures.Open reduction and internal fixation for diaphyseal fracture in the adults are generally accepted as the best method of treatment, even though closed reduction may be achieved. Objective: The Objective of this study is to evaluate the functional outcome after open reduction and internal fixation of the forearm diaphyseal fractures by Dynamic Compression Plate (DCP). Methods: This is a prospective study of 72 cases of diaphyseal both bone forearm fractures in adults who attended casualty and of Government Medical College Hospital, Kozikkode and were treated by open reduction and internal fixation with dynamic compression plating between September 2020 to August 2022. Results: The functional outcome as per DASH scoring system in dynamic compression plating (DCP) group was that 85 % (61 patients) had excellent results, 15 % (11 patients) had good results with no patient having fair and poor results. Conclusion: Fixation with Dynamic Compression Plate has stood the test of time and provides excellent fixation. DASH is a widely accepted standardized scoring system to assess upper limb function. In comparison with few of the previous studies our results are better in terms of functional outcome.

Refracture Following Operative Treatment of Pediatric Both Bone Forearm Fractures.

Both bone forearm fractures are common injuries in children. Most can be treated with reduction and casting. Those that fail nonoperative management can be treated with a plate or intramedullary fixation; however, refracture remains a problem. The goal of this study is to evaluate the refracture rate in both bone forearm fractures based on the mode of fixation. Institutional board review approval was obtained. A retrospective chart review from 2010 to 2021 at a single tertiary care institution was conducted for all operative patients <18 years who sustained a both bone forearm fracture. Groups were stratified based on initial operative fixation type: both bones fixated using nails, 1 bone fixated with a nail; both bones plated, and 1 bone plated. Further review was conducted to identify refractures following initial operative treatment. Statistical analyses were conducted using the χ 2 test of independence and Fisher's exact test. In all, 402 operatively treated both bone forearm fracture patients were identified. Two hundred fifty-six of these patients underwent intramedullary fixation (average age 10.3y/o), while 146 patients received plate fixation (average age 13.8y/o). Fracture location was similar across the nailing and plating cohorts, most often occurring in the mid-shaft region. Patients aged ≤10 years refractured at a significantly higher rate than patients aged >10 years across all operative fixation cohorts (12.5% vs. 2.5%, P <0.001). Among the 256 patients who underwent intramedullary fixation, 61.3% had both bones treated (n=157/256), whereas 38.7% received single bone fixation (n=99/256). Of the 146 plate fixations, 84.4% had both bones fixed (n=123/146), and only 15.8% were treated with single bone fixation (n=23/146). In the intramedullary group, 15 patients sustained refractures, 11 of whom were treated with single bone fixation (11.1%, n=11/99) versus 4 with both both fixation (2.5%, n=4/157). Among the plating group, 7 patients sustained refractures, 6 with both bone fixation (4.9%, n=6/123) and 1 in single bone fixation (4.3%, n=1/23). Refractures were found to be significantly more prevalent among patients treated with single bone compared with both bone intramedullary nail fixation (11.1% vs. 2.5%, P =0.006). By fixated bone, single bone ulna fixations had a higher refracture rate compared with both bone fixations (12.1% vs. 3.6%, P =0.003). The overall refracture rate following operative treatment of both bone fractures is 5.5% and is similar between intramedullary and plate fixations. Overall, patients ≤10 years of age had a higher rate of refracture. Among single bone fixations, higher refracture was seen with intramedullary fixations, and when the radius was treated nonoperatively. Surgeons may be able to reduce the refracture rate by performing intramedullary fixation of both bones instead of only one bone. Effective postoperative counseling among younger patients may also decrease refracture rates.

Community Water Fluoridation and Rate of Pediatric Fractures.

The effect of community water fluoridation on bone fragility and fracture has been inconclusive in the literature. The null hypothesis of this study was that no association was observed between water fluoride level and risk of fracture in children. Community fluoridation data were obtained from the Centers for Disease Control and Prevention while data on fracture rates were obtained from the PearlDiver database. The rate of fracture type for each state was then compared with state-level fluoridation data using Pearson correlation coefficients and Wilcoxon rank-sum tests. Positive correlations were found between the percentage of state water fluoridation and fracture rates for both bone forearm fracture (BBFFx) and femur fracture. Fluoride levels had positive correlations with fracture rates for all fracture types. Increased fracture rates were found between states in the highest quartiles of percentage of state water fluoridation and fluoride water levels for supracondylar humerus fracture and BBFFx. A higher level of water fluoridation was associated with higher rates of supracondylar humerus fracture and BBFFx in children aged 4 to 10 years. These findings do not imply causality, but they suggest that additional investigation into the effect of fluoride on pediatric bone health may be indicated.

THE EFFECTIVENESS OF CORRECTION OF HAND MOTILITY BY MEANS OF PHYSICAL THERAPY, OCCUPATION THERAPY (HAND THERAPY) IN THE REHABILITATION PROCESS OF MILITARY SERVANTS WITH THE CONSEQUENCES OF GUNSHOT POLYSTRUCTURAL FOREARM BONE FRACTURES

Aim: to evaluate the effectiveness of the developed program of hand therapy on the parameters of upper limb motility in wounded military servants with the consequences of a gunshot polystructural forearm bones fracture in the post-immobilization period&#x0D; Materials and methods. 49 military servants with the consequences of a gunshot polystructural forearm bone fractures were examined. The control group (23 persons) underwent rehabilitation according to general polyclinic principles. The main group (26 persons) underwent rehabilitation using tools and principles of hand therapy (therapeutic exercises and functional training for the wrist and fingers, forearm, shoulder, all joints of the upper limb, exercises on the mechanotherapeutic table MAPS THERAPY; Proprioceptive Neuromuscular Facilitation, massage of the upper limbs; kinesiological taping; orthotics) lasting 1 month. The effectiveness of the program was evaluated by the functioning of the upper limb when performing the Action Research Arm Test and dexterity by the Nine-hole peg test.&#x0D; Results. In the injured persons with the consequences of a gunshot polystructural fracture of the bones of the forearm in the post-immobilization period, deterioration of the motility of the upper limb according to the Action Research Arm Test and dexterity according to the Nine-hole peg test, which are factors of disruption of the normal functioning of the upper limb, were determined. After the rehabilitation intervention, all examined persons showed an improvement in motility according to the Action Research Arm Test in the control group by 14.7%, in the main group by 35.4%, according to the Nine-hole peg test - by 61.8% and 22.3%, respectively. According to all studied parameters, the patients of both groups showed a statistically significantly better result compared to the initial data (p&lt;0.05), however, the subjects of the main group showed a better result than the patients of the control group (p&lt;0.05).&#x0D; Conclusions. The hand therapy program demonstrated a statistically significantly better effect (p&lt;0.05) on all studied indicators of upper limb motility compared to the polyclinic rehabilitation program, which confirms the need for the use of specialized rehabilitation directions in patients with upper limb injuries that take into account the anatomical and physiological features of the hand and its role in activities of daily living.

Surgical outcomes of segmental diaphyseal forearm fractures in adults: a small case series on plate osteosynthesis, intramedullary nailing, and other surgical methods

BackgroundSegmental fractures often result from high-energy or indirect trauma that causes bending or torsional forces with axial loading. We evaluated surgical outcomes of patients with forearm segmental diaphyseal fractures.MethodsWe retrospectively analyzed data from patients with forearm segmental fractures for which they underwent surgery at the Pusan National University Trauma Center from March 2013 to March 2022. We also analyzed accompanying injuries, injury severity score (ISS), injury mechanism, occurrence of open fracture, surgical technique, and treatment results.ResultsFifteen patients were identified, one with bilateral segmental diaphyseal forearm bone fracture, for a total of 16 cases. Nine of the patients were male. The overall mean age was 50 years, and the mean follow-up period was 16.2 months. Six cases who underwent surgery using plate osteosynthesis achieved bone union without length deformity at final follow-up. Three of seven patients who underwent intramedullary nailing alone underwent reoperation due to nonunion. Six cases achieved bone union at final follow-up, three of which showed length deformity. Three patients underwent surgery using a hybrid method of IM nailing, plates, and mini cables. One patient who underwent surgery with a plate and one patient who underwent surgery with IM nailing alone showed nonunion and were lost to follow-up.ConclusionPlate osteosynthesis is considered the gold standard for treatment of adult forearm diaphyseal segmental fractures. In this study, IM nailing was associated with high rates of non-union and length deformity. However, the combination of IM nailing and a plate-cable system may be an acceptable alternative in segmental diaphyseal forearm fracture, achieving a union rate similar to that provided by plate fixation.

To Bury or Not to Bury the K-wires After Fixation of Both Bone Forearm Fractures in Patients Younger Than 11 Years Old: A Randomized Controlled Trial.

The primary objective was to compare the re-fracture incidence of both radius and ulna fracture in 2 groups treated using intramedullary Kirschner wires (K-wires) where the wires were exposed in group I and buried in group II. The secondary objective was to compare the final functional outcomes and complications incidence. Between March 2019 and February 2021, 60 pediatric patients with unstable radius and ulna fractures amenable to surgical intervention using intramedullary K-wires were randomized into group I (K-wires were exposed above the skin by 2cm) or group II (K-wires were buried under the skin). In group I, K-wires were removed in the outpatient clinic, while in group II, they were removed under general anesthesia as a day-case procedure. Functional outcome per Price criteria was reported at 1-year follow-up. Included patients had a mean age of 7.6 years (range: 5 to 10y). The mean operative time was significantly higher in group II (32.33±7.51 vs. 36.77±8.70min, P =0.03), with no difference regarding intraoperative x-ray exposure (43.12±15.52 vs. 41.6±11.96s, P =0.67). Fracture union was achieved after a mean of 44±2.6 days in group I and 43±1.87 days in group II, with no difference between both groups ( P =0.34). One patient had re-fracture in group I and no patients in group II; however, the difference was insignificant ( P =0.12). Infection occurred in 2 patients in each group. All patients reported excellent scores per Price criteria and achieved full wrist and elbow range of motion compared with the contralateral noninjured side. Exposed implants are a safe option when dealing with forearm fractures in patients younger than 11 years old, with the added advantage of fewer hospital admissions. Furthermore, it had a similar complication rate and functional outcomes compared with buried implants. ClinicalTrials.gov, NCT03906929. Level II.

Outcomes and complications of Titanium elastic nailing for forearm bones fracture in children: our experience in a district general hospital in the United Kingdom.

Intramedullary Titanium elastic nailing (TENS) is successfully used for irreducible and displaced forearm bone fractures in children. The purpose of this study was to report the potential complications and functional outcomes associated with paediatric forearm fractures treated with TENS nails. We retrospectively reviewed 65 children with displaced forearm bone fractures treated by TENS nailing with a mean follow-up of 5.84 months (4-12). Data detailing patient demographics, fracture characteristics, associated fractures, injury surgery interval, grade of the operating surgeon, methods of fixation, time to union, the timing of removal of the nail, and complications were collected and analysed. The mean age in our study was 9.13 years. 92% had fractures of both radius and ulna, 83.3% had fixation of both bones, and 16.7% had single bone fixation only. Open reduction was required in 38.5% of cases. The average time to fracture union was 10.34 weeks (6-20). The average time of implant removal was 20.12 weeks (9-32). We observed an overall complication rate of 41.5%. We noted a higher (56% vs 32.5%, p=0.059) complication rate in open reduction cases. According to the Price criteria, we had excellent to good results in over 98% of patients despite a slightly higher complication rate. Titanium elastic nailing is a safe, reliable method of internal fixation for irreducible or unstable fractures of both bones of the forearm in children. Open reduction of fracture was associated with higher complications. Despite higher overall complications, we noted excellent functional results in most cases.