Year 2020, Volume 6 , Issue 5, Pages 500 - 507 2020-09-04

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Nazan ÇEVİK [1] , Yavuz AKALIN [2] , Alpaslan ÖZTÜRK [3]


Objectives: The results of two different methods applied in the surgical treatment of forearm fractures in adults were evaluated.

Methods: Thirty-nine patients who applied to our clinic between 2016-2018 and were treated surgically were included in the study. Twenty-three patients out of these were treated with plate osteosynthesis (group 1), and 16 patients were treated with intramedullary locking nail (group 2). While 14 of the patients in group 1 were male, 9 were female, and the average age was 39.8 years (range; 19-74 years); and 11 of the patients in group 2 were male, 5 were female, and the average age was 36.6 years (range; 18-68 years). Patients were called for monthly check-ups until fracture union. Then, radiographic evaluation was done at 3, 6 and 12 months. The average follow-up time was 26 months (range;12-36 months) for group 1 and 25 months (range;12-35 months) for group 2. The loss of the line of fracture through radiographic imaging of trabeculations or callus formation in the cortex on the anteroposterior and lateral radiographs, and clinically loss of sensitivity on fracture were considered fracture union. In the last controls, while the elbow was at 90 degrees of flexion, the amount of rotation of both forearms was measured by using the goniometer. In the functional evaluation, the system described by Grace and Eversmann and used to evaluate fracture union and forearm rotation was used. Patient satisfaction was evaluated by using the DASH (Disabilities of the Arm, Shoulder and Hand) method.

Results: While the union duration in group 1 was 12.3 weeks (range; 8-18 weeks), the union duration in group 2 was 12 weeks (range; 9-16 weeks). There was no statistical difference in terms of union durations (p > 0.05). In Group 1, according to the Grace-Eversmann evaluation, 19 (82.6%) patients had excellent and good results, three (13.1%) patients had acceptable results, and 1 (4.3%) patient had poor results. Forearm pronation of the patient with poor results was less than 60% but his bone union was complete. In group 1, the average DASH score was 15.04 (range; 3-28). In group 2, Grace-Eversmann evaluation showed excellent and good results in 13 (81.3%) patients and acceptable results in 3 (18.7%) patients. Average DASH score was found to be 14.6 (range; 2-34). When Grace-Eversmann criteria and DASH values were compared, no significant difference was found between the two groups (p > 0.05). Vascular nerve injury, tendon injury, radioulnar synostosis, and compartment syndrome were not observed in any patient.

Conclusions: The results of the two fixation methods in terms of functional recovery and patient satisfaction were similar in the surgical treatment of forearm double fractures in adults. 

Adult, forearm diaphyseal fractures, intramedullary locking nail, plate osteosynthesis
  • 1. Markolf KL, Lamey D, Yang S, Meals R, Hotchkiss R. Radioulnar load-sharing in the forearm. A study in cadavera. J Bone Joint Surg Am 1998;80:879-88.
  • 2. Abe S, Murase T, Oka K, Shigi A, Tanaka H, Yoshikawa H. In vivo three-dimensional analysis of malunited forearm diaphyseal fractures with forearm rotational restriction. J Bone Joint Surg Am 2018;100:e113.
  • 3. Özbal R, Tezer M, Koçkesen TC, Özturk İ, Kuzgun Ü. Selection of osteosynthesis material in the surgical treatment of adult forearm diaphyseal fractures. Acta Orthop Traumatol Turc 2000;34:164-9.
  • 4. Lee SK, Kim YH, Kim SM, Choy WS. A comparative study of three different surgical methods for both-forearm-bone fractures in adults. Acta Orthop Belg 2019;85:305-16.
  • 5. Crenshaw AH Jr. Fractures of shoulder, arm and forearm. In: Canale ST, Daugherty K, Jones L, Azar FM, Beaty JH, Calandruccio JH, et al. editors. Campbell’s operative orthopaedics. 10th ed. St. Louis: Mosby; 2003. p. 2985-3069.
  • 6. Grace TG, Eversmann WW Jr. Forearm fractures: Tteatment by rigid fixation with early motion. J. Bone and Joint Surg 1980;62:433-8.
  • 7. Boussakri H, Elibrahimi A, Bachiri M, Elidrissi M, Shimi M, Elmrini A. Nonunion of fractures of the ulna and radius diaphyses: clinical and radiological results of surgical treatment. Malays Orthop J 2016;10:27-34.
  • 8. Tabor OB Jr, Bosse MJ, Sims SH, Kellam JF. Iatrogenic posterior interosseous nerveinjury: is transosseous static locked nailing of the radius feasible? J OrthopTrauma 1995;9:427-9.
  • 9. Behnke NM, Redjal HR, Nguyen VT, Zinar DM. Internal fixation of diaphyseal fractures of the forearm: a retrospective comparison of hybrid fixation versus dual plating. J Orthop Trauma 2012;26:611-6.
  • 10. Bartoniček J, Kozanek M, Jupiter JB. History of operative treatment of forearm diaphyseal fractures. J Hand Surg Am 2014;39:335-42.
  • 11. Sage FP. Medullary fixation of fractures of the forearm. A study of the medullary canal of the radius and a report of fifty fractures of the Radius treated with a prebent triangular nail. J Bone Joint Surg Am 1959;41-A:1489-516.
  • 12. Groover MT, Hinkley JR, Gerow DE, Bamberger HB, Evans J, Gazaille RE. The effect of metal instrumentation on patient and surgical team scatter radiation exposure using mini C-arm in a simulated forearm fracture fixation model. J Am Acad Orthop Surg Glob Res Rev 2019;3:e089.
  • 13. Anderson LD, Sisk D, Tooms RE, Park WI 3rd. Compression-plate fixation in acute diaphyseal fractures of the Radius and ulna. J Bone Joint Surg Am 1975;57:287-97.
  • 14. Stevens CT, ten Duis HJ. Plate osteosynthesis of simple forearm fractures: LCP versus DC plates. Acta Orthop Belg 2008;74:180-3.
  • 15. Kose A, Aydın A, Ezirmik N, Topal M, Can CE, Yılar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulus Travma Acil Cerrahi Derg 2016;22:184-91.
  • 16. Kose A, Aydin A, Ezirmik N, Topal M, Can CE. Treatment of isolated ulnar fractures in adults with a new intramedullary nail. Minerva Ortop Traumatol 2015;66:123-31.
  • 17. Visńa P, Beitl E, Pilny J, Cizmar I, Vlcek M, Kalvach J, et al. Interlocking nailing of forearm fractures. Acta Chir Belg 2008;108:333-8.
  • 18. Gao H, Luo CF, Zhang CQ, Shi HP, Fan CY, Zen BF. Internal fixation of diaphyseal fractures of the forearm by interlocking intramedullary nail: short-term results in eighteen patients. J Orthop Trauma 2005;19:384-91.
  • 19. Lee YH, Lee SK, Chung MS, Baek GH, Gong HS, Kim KH. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am 2008;90:1891-8.
  • 20. Köse A, Aydın A, Ezirmik N, Yıldırım ÖS. A comparison of the treatment results of open reduction internal fixation and intramedullary nailing in adult forearm diaphyseal fractures. Ulus Travma Acil Cerrahi Derg 2017;23:235-44.
  • 21. Kim SB, Heo YM, Yi JW, Lee JB, Lim BG. Shaft fractures of both forearm bones: the outcomes of surgical treatment with plating only and combined plating and intramedullary nailing. Clin Orthop Surg 2015;7:282-90.
  • 22. Ozkaya U, Kiliç A, Ozdoğan U, Beng K, Kabukçuoğlu Y. Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures. Acta Orthop Traumatol Turc 2009;43:14-20.
  • 23. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). [corrected]. The Upper Extremity Col- laborative Group (UECG). Am J Ind Med 1996;29:602-8.
  • 24. Bulstra LF, Schep NWL, van der Vlies CH. Posterior interosseous nerve palsy after closed proximal forearm fractures. Trauma Case Rep 2019;23:100240.
  • 25. Moerman J, Lenaert A, De Coninck D, Haeck L, Verbeke S, Uyttendaele D, et al. Intramedullary fixation of forearm fractures in adults. Acta Orthop Belg 1996;62:34-40.
Primary Language en
Subjects Orthopedics
Journal Section Original Articles
Authors

Orcid: 0000-0002-9596-8502
Author: Nazan ÇEVİK (Primary Author)
Institution: Department of Orthopaedics and Traumatology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0001-7967-7054
Author: Yavuz AKALIN
Institution: Department of Orthopaedics and Traumatology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0001-7362-0284
Author: Alpaslan ÖZTÜRK
Institution: Department of Orthopaedics and Traumatology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Dates

Application Date : February 28, 2020
Acceptance Date : July 11, 2020
Publication Date : September 4, 2020

EndNote %0 The European Research Journal The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail %A Nazan Çevi̇k , Yavuz Akalın , Alpaslan Öztürk %T The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail %D 2020 %J The European Research Journal %P -2149-3189 %V 6 %N 5 %R doi: 10.18621/eurj.694212 %U 10.18621/eurj.694212