Comparative analysis of bone fixation in patients with uncomplicated multiple fractures and fracture-dislocations of the forearm

Abstract

Introduction The functional anatomy of the forearm sets up requirements for the choice of fixation constructs and medical technologies of osteosynthesis to be used for particular localization and pattern of injury. Objective was to evaluate the effectiveness of intramedullary nailing, plating, external fixation and combined techniques used to repair forearm shaft fractures of different severity based on comparative analysis of outcomes. Material and methods Outcomes of 153 patients with forearm shaft fractures treated with IM nailing, plating, external fixation (controls, n = 78; 51.0 %) and combined osteosynthesis with shape memory devices (index group, n = 75; 49.0 %) were comparatively analyzed using criteria offered by Anderson L.D. (consolidation time) and Grace T.G., Eversman W.W. (functional results) and statistical methods. Patients sustained either an isolated fracture of one bone (n = 62; 40.5 %) or combined both bones forearm injuries (n = 44; 28.8 %). A subgroup of complicated injuries included 25 (16.3 %) patients with fracture-dislocations and 22 (14.4 %) patients with multiple fractures (bifocal, comminuted, bone loss of at least 5.0 cm). Results Plating of isolated and combined forearm injuries showed significant advantages over intramedullary nailing with square nail (χ2 = 5.329, p = 0.021). Intramedullary nailing appeared to be more efficacious when supported by thermomechanical memory devices and could be comparable with the results achieved with plating (χ2 = 0.070, p = 0.792). Combined techniques with thermomechanical memory devices were practical for multiple fractures and fracture-dislocations (χ2 = 6.649, p = 0.010). Conclusions Intramedullary nailing with square nails was shown to be efficient in 50.0 % of patients with transverse, oblique fractures of one or both forearm bones and in 20.0 % of fracture-dislocations. The bone consolidated and function recovered in 85.3 to 95.2 % of the patients with of one or both forearm bones fractures repaired either with plating or combined methods with the use of shape memory constructs. Patients with fracture-dislocations, comminuted and segmental fractures showed good results in 75.0 % of the cases addressed with external fixation and external fixation combined with shape memory devices, and in 42.9 % of cases repaired with plating.

Keywords

• forearm
• fracture
• comminution
• segmental fracture
• external fixation
• intramedullary nailing
• plating
• shape memory device
• outcome