Comparison of clinical and functional outcomes of patients who underwent plate osteosynthesis and intramedullary nailing for forearm fractures

Abstract

Aims: The aim of this study was to compare the functional and radiographic results of patients with forearm diaphyseal fractures after intramedullary nailing (IMN) and plate and screw osteosynthesis. Methods: A total of 58 patients, including 31 patients operated on with the plate osteosynthesis method and 27 patients operated on with the IMN method for forearm diaphyseal fractures between 2017 and 2022, were retrospectively analyzed. The mean age was 35.9±14.5 years in the plate group and 33±13.1 years in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group. Evaluation criteria for functional outcomes were forearm pronation; supination range of motion; the Disabilities of the Arm, Shoulder, and Hand (DASH) score; and the Grace-Eversmann score. Results: The mean union time was 66.7 days in the plate group and 54.4 days in the IMN group (p=0.039). The mean length of hospitalization was 3.9±3.44 days in the plate group and 2.93±1.49 days in the IMN group. The mean supination range was 72.5±9.9 degrees in the plate group and 72.2±11.8 degrees in the IMN group. The mean pronation range was 81.2±11.7 degrees in the plate group and 80.3±15.5 degrees in the IMN group. The mean follow-up period was 157±83 days in the IMN group and 220±97 days in the plate group (p=0.011). According to the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA) classification, 30 cases were classified as type A, 21 cases as type B, and 7 cases as type C. According to the Grace-Eversmann classification, 2 cases in the plate group were classified as unacceptable, 2 were classified as acceptable, 10 were classified as good, and 16 were classified as excellent, while 2 cases in the IMN group were classified as unacceptable, 4 were classified as acceptable, 5 were classified as good, and 16 were classified as excellent. The mean DASH score was 14.74±10.49 in the plate group and 15.11±12.7 in the IMN group. Conclusion: With the advantages of minimal incision, less soft tissue damage, and no evacuation of the fracture hematoma, the union time and follow-up periods were found to be shorter in the IMN group. Thanks to the bearing force of intracanal intramedullary nails, patients were able to move earlier and satisfactory functional outcomes were obtained.

Keywords

• Forearm fracture
• intramedullary nailing
• plate osteosynthesis
• ulna fracture
• radius fracture

Önkol kırıklarında plak ile osteosentezi ve intramedüller çivileme uygulanan hastaların klinik ve fonksiyonel sonuçlarının karşılaştırılması ​

Abstract

Amaç: Bu çalışma ön kol diyafiz kırığı olan hastaların tedavisinde intramedüller çivileme (IMN) ve plak ve vida osteosentezi sonrası fonksiyonel ve radyografik sonuçları karşılaştırmayı amaçladı. Yöntemler: Çalışmada 2017 ile 2022 tarihleri arasında ön kol diyafiz kırıkları nedeniyle plak ile osteosentez yöntemiyle opere edilen 31 hasta ve İMN yöntemi ile opere edilen 27 hasta olmak üzere toplamda 58 hasta retrospektif olarak incelendi. Ortalama yaş plak grubunda 35.9±14.5 yıl, IMN grubunda ise 33±13.1 yıl idi. Ortalama takip süresi IMN grubunda 157±83 gün, plak grubunda ise 220±97 gün idi. Fonksiyonel sonuçlar, ön kol pronasyon, supinasyon hareket açıklığı, Disabilities of the Arm, Shoulder and Hand (DASH) skoru ve Grace-Eversmann skorlama kriterlerine göre değerlendirildi. Bulgular: Kaynama süresi plak grubunda 66.7 gün, IMN grubunda ise 54.4 gündü (p=0,039). Ortalama yatış süresi plak grubunda 3.9±3.44 gün olarak İMN grubunda 2.93±1.49 olarak saptandı. Ortalama supinasyon açıklığı plak grubunda 72.5±9.9 derece, İMN grubunda 72.2±11.8 derece olarak saptandı. Ortalama pronasyon açıklığı plak grubunda 81.2±11.7 derece, İMN grubunda 80.3±15.5 derece olarak saptandı. Hastaları takip zamanı plak grubunda 220.6±97.5 gün, İMN grubunda 157.7±83 gün olarak saptandı (p=0.011). Association for Osteosynthesis/Orthopedic Trauma Association classification (AO/OTA) sınıflamasına göre 30 hastada tip A, 21 hastada tip B, 7 hastada tip C olarak belirlendi. Sınıflamaya göre kırık kaynama süresinde anlamlı bir farklılık saptanmadı. Grace Eversmann sınıflamasında plak grubunda 2 hastada kabul edilemez, 2 hastada kabul edilebilir, 10 hastada iyi, 16 hastada mükemmel olarak, İMN grubunda 2 hastada kabul edilemez, 4 hastada kabul edilebilir, 5 hastada iyi, 16 hastada mükemmel olarak saptandı. DASH skorlamasında plak grubunda ortalama 14.74±10.49 olarak, İMN grubunda 15.11±12.7 olarak saptandı. Sonuç: Minimal insizyon, daha az yumuşak doku zararı, kırık hematomunun boşaltılmaması gibi avantajların etkisiyle İMN grubunda kaynama süresi daha kısa bulundu ve buna bağlı olarak hasta takip süreleri de kısa bulundu. Hastalarda İMN’nin kanal içi olması sebebiyle taşıma kuvvetine güvenilerek erken hareket başlandı ve fonksiyonel açıdan tatmin edici sonuçlar elde edildi

Keywords

• Ön kol kırığı
• İntramedüller çivileme
• Plak ile osteosentez
• Ulna kırığı
• Radius kırığı

References

1. Orbay JL, Cambo RA. Biomechanical factors in stability of the forearm. Hand Clin. 2020;36(4):407-415. doi: 10.1016/j.hcl.2020. 06.001
2. LaStayo PC, Lee MJ. The forearm complex: anatomy, biomechanics and clinical considerations. J Hand Ther. 2006;19(2):137-144. doi: 10.1197/j.jht.2006.02.002
3. Soubeyrand M, Assabah B, Bégin M, Laemmel E, Dos Santos A, Crézé M. Pronation and supination of the hand: anatomy and biomechanics. Hand Surg Rehabil. 2017;36(1):2-11. doi: 10.1016/j.hansur.2016.09.012
4. Hong DY, Berube ER, Strauch RJ. Non-operative management of adult both bone forearm fractures - a case report and literature review. J Orthop Case Rep. 2020;10(7):53-56. doi: 10.13107/jocr.2020.v10.i07.1916
5. Dodge HS, Cady GW. Treatment of fractures of the radius and ulna with compression plates. J Bone Joint Surg Am. 1972;54(6): 1167-1176.
6. Blažević D, Benčić I, Ćuti T, et al. Intramedullary nailing of adult forearm fractures: results and complications. Injury. 2021;52 (Supplement 5):S44-S48. doi: 10.1016/j.injury.2020.11.012
7. Gadegone W, Salphale YS, Lokhande V. Screw elastic intramedullary nail for the management of adult forearm fractures. Indian J Orthop. 2012;46(1):65-70. doi: 10.4103/0019-5413.91637
8. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am Acad Orthop Surg. 2014;22(7):437-446. doi: 10.5435/JAAOS-22-07-437

9. Köse A, Aydın A, Ezirmik N, Topal M, Can CE, Yılar S. Intramedullary nailing of adult isolated diaphyseal radius fractures. Ulus Travma Acil Cerr Derg. 2016;22(2):184-191.
10. Köse A, Aydın A, Ezirmik N, Can CE, Topal M, Tipi T. Alternative treatment of forearm double fractures: new design intramedullary nail. Arch Orthop Trauma Surg. 2014;134(10):1387-1396. doi: 10.1007/s00402-014-2058-9
11. Saka G, Saglam N, Kurtulmus T, et al. Treatment of isolated diaphyseal fractures of the radius with an intramedullary nail in adults. Eur J Orthop Surg Traumatol. 2014;24(7):1085-1093.
12. 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(1):14-20. doi: 10.3944/AOTT.2009.014
13. Kibar B, Kurtulmuş T. Comparison of new design locked intramedullary nails and plate osteosynthesis in adult isolated diaphyseal radius fractures. Eur J Trauma Emerg Surg. 2020; 46(6):1429-1435. doi: 10.1007/s00068-019-01131-3
14. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32:S1-S10. doi: 10.1097/BOT.0000000000001063
15. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-458.
16. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med. 1996;29(6):602-608. doi: 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
17. Grace TG, Eversmann WW. Forearm fractures: treatment by rigid fixation with early motion. J Bone Joint Surg Am. 1980;62(3):433-438.
18. Polat O, Toy S. Comparison of the clinical and radiographic outcomes of plate fixation versus new-generation locked intramedullary nail in the management of adult forearm diaphyseal fractures. Acta Orthop Traumatol Turc. 2022;56(5):321-326. doi: 10.5152/j.aott.2022.21190
19. Savajiyani D, Chauhan N, Ramavat S. The outcomes of intra-medullary square nail for adult both bone forearm shaft fractures. J Orthop Spine Trauma. 2023;9(3):125-128. doi: 10.18502/jost.v9i3.13021
20. Visna P, Vlcek M, Valcha M, Beitl E, Jaganjac E, Smídl Z. Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing. Rozhl Chir. 2009;88(12):708-715.
21. Weckbach A, Blattert TR, Weisser C. Interlocking nailing of forearm fractures. Arch Orthop Trauma Surg. 2006;126(5):309-315. doi: 10.1007/s00402-006-0122-9
22. Lee SK, Kim KJ, Lee JW, Choy WS. Plate osteosynthesis versus intramedullary nailing for both forearm bones fractures. Eur J Orthop Surg Traumatol. 2014;24(5):769-776. doi: 10.1007/s00590-013-1242-x
23. Saka G, Saglam N, Kurtulmuş T, et al. New interlocking intramedullary radius and ulna nails for treating forearm diaphyseal fractures in adults: a retrospective study. Injury. 2014;45(Supplement 1):S16-S23. doi: 10.1016/j.injury.2013.10.040
24. 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(6):384-391. doi: 10.1097/01.bot.0000157911.76433.db