Management of fracture both bones forearm with plating/medullary nailing: A comparative study

Abstract

Introduction: Fracture of both bones forearm in adults occupy a large field of modern traumatology. Maintenance of radial bow, regaining length, good apposition and alignment without malrotation is essential to restore good range of motion of forearm. Aim: to compare functional and radiographic results of plate osteosynthesis to IM nailing in treatment of diaphyseal forearm fracture in adults.Method: A prospective study comprising of 32 patients. 16 patients treated with open reduction and internal fixation using 3.5 mm DCP and 16 patients by IM nailing using 316L SS Talwarkar square nailing by closed or mini open reduction.Result: Mean age of patients was 36.4 years (range 20 to 58 years), Maximum number of patients in this study are middle age group and mean age is 48 years most fractures were of type 22A3 as per AO/OTA classification. Average operative time was 83 minutes and 64 minutes in plating and nailing respectively. Out of 16 patients in each group in our present study we encountered complications like restriction of movements at elbow in 5 (31.25%) plating cases and 3 (18.75%) nailing cases; restriction of movements at wrist in 1(6.25%) plating case and 0 nailing cases and loss of supination or pronation or both were observed in 6 (37.5%) each in nailing and plating cases. Localised bursitis were observed in 2 (12.5) nailing cases alone & wound healing and superficial infections were observed in 2 (6.25%) plating cases alone. We had 1 (6.25%) Non-Union is case of Plating and all fractures united in cases operated with nailing. Out of the 32 sample cases, taking into the account of our functional grading we have observed that about 9 (56.25%) cases have been graded with excellent outcome in plating group and 10 (62.5%) in nailing group, similarly about 5 (31.25%) have been graded with good outcome in plating and 3 (18.75%) in nailing group respectively and satisfactory outcome in 1 (6.25%) in plating group and 3 (18.75%) in nailing group. This has been only 1 (6.25%) case which had a Poor outcome in plating group in our study.Conclusion: We conclude that open reduction and internal fixation with dynamic compression plating is gold standard for treating diaphyseal forearm fracture in adults as it provides rigid fixation, restores forearm stability earlier and has negligible complications.