Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing

BACKGROUND: Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs. METHODS: Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent. CONCLUSIONS: The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.

[ evaluation of proximal tibia osteotomy by lateral closing wedge [Coventry] method in association with displacement of distal part to proximal and rigid fixation by T-plate and rapid range of motion]

The objective of this study was the evaluation of genovarum adjustment and the effect of distal part of osteotomy displacement and comparing it with other methods and determination of its complications. A total of 25 knees from 22 patients in 1381-1383 in Baghiatallah Hospital were undergone proximal tibia osteotomy by lateral closing wedge [Coventry] method with rigid fixation by T-plate and rapid range of motion [ROM]. In all patients the distal of osteotomy part was displaced about 1 cm to proximal and was fixed rigidly with a T-plate. ROM and 50% weight bearing with 2 crutches were begun at second day after surgery. After 6 weeks both crutches were put away. Patients were visited again at the end of weeks 4, 6, 8, and 16 and tibio-femoral angle and ROM were measured and registered. Every probable complication and union at any time and patient's satisfaction and the time of getting back to work were registered at the fourth month. The mean of genovarum was 12 degrees varus before surgery which was adjusted to 6.1 degrees valgus after surgery. The majority of patients were able to walk without crutches at the end of the second month. There was union in all patients at the end of the third month. At the end of the fourth month all patients got back to previous activities. There was pain in only one patient [2 knees], but it was milder than before and the patient was satisfied. It seems this kind of operation is more advantages than other methods especially non-rigid fixation and casting in patients older than 40 with osteoarthritis and no tolerance to being immobilized in cast and also with high complication risks such as vascular thrombosis