Four-Screw Plate Fixation vs Conventional Fixation for Diaphyseal Fractures of the Forearm

Background: Standard treatment of diaphyseal fractures of the forearm is open reduction and fixation using dynamic compression plates (DCP) and screws. This technique uses screw placement in all ۶ or more of the plate holes except the hole over the fracture line. We hypothesized that DCP with selective ۴-screw bicortical placement can provide adequate fixation for these fractures. Objectives: The aim of this study was to evaluate the results of conventional ۶ or more screw fixation versus ۴ screw fixation for adults with diaphyseal fractures of the forearm. Patients and Methods: In this prospective study, ۱۲۸ fractures of the ulna, radius or both bones of the forearm in ۸۷ patients were treated in either one of these two groups: Open reduction and internal fixation (ORIF) with conventional DCP and screws or ORIF using DCP and selective ۴- screw placement. Fractures were transverse or oblique in pattern without gross comminution. In a total of ۴۱ patients with fractures, ۲۸ single ulnar and ۱۸ single radius fractures were included. Follow-up visits were done at ۳-۶ and ۱۲-۱۶ weeks and at ۶ months. Outcome with respect to union an nonunion rates, union time, infection, and device failure was noted. Results: No change in alignment was noted in any patient. Union time in conventional and selective bicortical ۴-screw fixation was ۷۴.۸ days and ۷۳.۶ days respectively which showed no significant difference (P = ۰.۰۶۴). Union rate and infection was ۹۲.۱% and ۳.۲% in conventional and ۹۵.۳% and ۰% in the selective group respectively. Non-union was observed in ۵ and ۳ cases of fractures in conventional and the selective group respectively. Conclusions: For treatment of the transverse or oblique diaphyseal fractures of the forearm, fixation by a same length ۳.۵ mm DCP with selective ۴-screw cortical fixation (۲ screws on each side of the fracture site) had similar results in comparison with conventional ۶ or more DCP screws. Because of lesser impact on host bone and smaller incision, the selective ۴-screw insertion can be an alternative technique for treatment of these fractures.

Keywords:

Forearm , fracture , Fixation