Isolated and combined fractures of the diaphysis of the radius and ulna

Comparison of new design locked intramedullary nails and plate osteosynthesis in adult isolated diaphyseal radius fractures

PURPOSE

In this study, we retrospectively evaluated patients with isolated diaphyseal radius fractures treated with plates or IMNs and compared their radiological and functional results.

METHODS

49 patients who met the criteria were included in the study. Of these, 22 were treated with plate osteosynthesis and 27 with IMNs. The mean age of plate group was 36.8 (range 17-68), IMN group was 34.3 (range 18-74). 39 (79.6%) of the patients were males and 10 (20.4%) were females. The mean follow-up period was 26 (range 12-48) months.

RESULTS

The mean union time was 12.1 ± 0.9 weeks in the IMN group and 12.2 ± 1.2 weeks in the plate group. Union was achieved in all patients in the IMN group (100%) and in 21 of 22 patients in the plate group (95.4%). The mean operation time was 21 (range 15-35) min in the IMN group and 46 (range 40-110) min in the plate group. There was no statistically significant difference between groups according to DASH scores, Grace-Eversmann evaluations, grip strength, forearm pronation and supination degrees, type of fracture, length of hospital stay, and time between injury and surgery (p > 0.05). Complete elbow and wrist range of motion was achieved in all patients.

CONCLUSIONS

With similar union rates, functional results, and shorter operating times, locked IMNs are a suitable alternative to plate osteosynthesis in adult isolated diaphyseal radius fractures.

Diaphyseal forearm fractures, 20 years after surgical treatment. Is there still an indication for percutaneous fixation?

OBJECTIVE

This is a retrospective study of 98 diaphyseal forearm fractures in adults, treated by a percutaneous technique with intramedullar Kirchner wires.

MATERIALS AND METHOD

We reviewed 64 patients with 98 forearm fractures with a radiographic follow-up, assessing the presence of pseudarthrosis or delayed bone union and evaluating functional outcomes with the Anderson and the Disability of the Arm, Shoulder and Hand scale.

RESULTS

Clinical and radiological bone union was achieved in an average of 12 weeks. We obtained 77% of excellent and good results following Anderson's scale. There were 4 cases of pseudarthrosis and 6 cases of delayed bone union.

CONCLUSION

This surgical technique provides several advantages, such as a low incidence of complications and a total absence of infections, refractures and iatrogenic neurovascular injuries. It allows a lower hospital stay and a shortening of the surgery time compared with other techniques such as plates and intramedullary nails, that have similar results, in terms of bone union and functional outcomes, as we have verified from the published literature.

Treatment of isolated diaphyseal fractures of the radius with an intramedullary nail in adults

BACKGROUND

The goal of the radius diaphysis fractures in surgical treatment is restoration of bone length, rotation correction and to secure fixation that allows early mobilization. The purpose of this study is evaluating the results of intramedullary (IM) radius nail for the treatment of isolated adult diaphyseal fractures of the radius.

MATERIALS AND METHODS

We retrospectively reviewed adults with isolated fractures of the radius, who were treated with closed or mini open reduction with a IM radius nail between May 2008 and November 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture, or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores.

RESULTS

Twenty-three enrolled patients (mean age 34 years; 17 men) had 23 isolated radius fractures. Mean time to fracture union was 12 weeks (range 10-13 weeks) for radius fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Follow-up ranged from 12 to 42 months. Grace and Eversmann ratings of 21 patients were excellent or good, and 2 patients were medium. Mean DASH score was 4.2 points (range 0-13.3).

CONCLUSIONS

Our experience indicates that this new IM radius nail may be considered as an alternative to plate osteosynthesis for fractures of the radius diaphysis in adults. IM nailing of radius fractures provides reliable bony union and excellent postoperative clinical results in adults.

Management of isolated ulnar shaft fractures

Isolated fractures of the ulnar shaft are common forearm injuries. Although seemingly benign, they may be complicated by nonunion, radioulnar synostosis, and loss of motion. Unstable fractures are those that are displaced more than 50 percent, angulated more than 10 degrees, or are located in the proximal third of the ulna. Stable fractures are managed well with forearm bracing. Unstable fractures are reliably treated with open reduction and internal fixation with compression plating.

Surgical treatment of open diaphyseal fractures of both the radius and ulna

BACKGROUND

This study was designed to determine the effects of surgical treatment of acute, open and displaced diaphyseal fractures of both the radius and ulna by early debridement, reduction and internal fixation with a dynamic compression plate (DCP).

METHODS

From 1991 to 2003, data from 25 patients with acute, open and displaced diaphyseal fractures of both the radius and ulna were collected and evaluated retrospectively. Twenty-four patients were managed with early surgical debridement, open reduction and internal fixation with a DCP, and 1 fracture was reduced and fixed 3 days after the initial injury. The mean follow-up period was 74.7 months (standard deviation [SD], 38.6 months; range, 16-150 months). All patients had complete functional and radiographic assessments.

RESULTS

Twenty-four patients (96%) achieved normal union in a mean of 20.2 weeks (SD, 3.8 weeks; range, 12-24 weeks). One patient with an open type I fracture had nonunion. Functional outcomes showed that 15 patients had excellent results, 8 had satisfactory results, 1 had an unsatisfactory result, and there was 1 failure. There was 1 delayed superficial wound infection.

CONCLUSION

Early meticulous debridement, good open reduction and internal fixation with a small DCP proved very effective in the management of type I and II open fractures of both the radial and ulnar diaphyses.