Subhash Patil¹, Kanakachalapathi^2*

¹Associate Professor, ²Assistant Professor, Department of Orthopaedics, Rims, Raichur, INDIA.

Email: drkcp01@yahoo.com

RESULTS

The present study consists of 30 cases of fracture both bones of the forearm. The age of these patients ranged from 18-60 years with fracture being most common in 3^rddecade and an average age of 31 years. Other common characteristics were males (80%), right forearm fracture (60%) and injury due to road traffic accidents (60%).

Table 1: General characteristics

Majority of the fractures were seen in the mid diaphysis of both bones. 21(70%) patients had middle third fractures, 6(20%) had proximal third fractures and 3 (10%) patients had lower third fractures both bonesforearm. Only 6 (20%) of the patients had associated injuries.

Table 2: Fracture characteristics

Majority of the fractures were transverse / short oblique. About 20% of radius and 30%of ulna fractures were communited.

Table 3: Type of the fracture

In our study, we noted the duration of surgery ranged from 60 to 95 minutes, with average time of 80 minutes. The tourniquet time ranged from 40 to 60 minutes, with average time of 49 minutes. 27(90%) patients had sound union in less than 6 months, 3 (10%) patients had delayed union.

Table 5: Duration of fracture union

There were no cases of intraoperative complications. Postoperative complications such as Superficial Infections (3.3 %), Posterior interosseous nerve injury (6.7 %), Radioulnar synostosis (3.3 %) were noted.

Table 5: Complications

Using the Anderson et al. scoring system we had 26 (86.7%) patients with excellent results, 3 (10%) patients with satisfactory results and 1 (3.3%) patients with unsatisfactory result (radioulnar synostosis).

Table 6: Functional outcome

DISCUSSION

Fracture both bones of forearm are commonly encountered in day-to-day orthopaedic practice in our hospital and it presents a formidable challenge to the orthopaedicians, as the various muscle forces acting upon the fracture tend to displace it. Hence to provide the functional rehabilitation of the upper limb, anatomic reduction and rigid fixation is mandatory. As reported by Knight and Purvis closed reduction and its maintenance is difficult.⁴ Intramedullary nails have got high failure rate. Though there are few advantages like closed nailing, minimal tissue dissection and hospital stay. So, the best option is plating. Different types of plates are available. The dynamic compression plates (DCP) give good results, but there are few disadvantages. Since these plates interfere with periosteal circulation, osteoporosis and refracture are very common after plate removal. Much work had not been done on PC-fixators and as reported by Frankie Leung et al.. they have no added advantage over theLC-DCP.⁵ The LC-DCP is the technically a further development of the DCP. The symmetrical self-compressing plate hole and deletion of the elongated distance between the innermost screw holes makes the LC-DCP more versatile for use in any fracture type. Grooves on the under surface of the LC-DCP serve three purposes: Improved blood circulation by decreased damage to contact between plate and bone. Allows for a small bone bridge beneath the plate at the most critical area, which is otherwise weak due to a stress concentration effect. More even distribution of the plate than in conventional plates.⁶ In the present study, fracture was common in third and fourth decade with average age of 31 years (18-55 years). Chapman et al. noted 70% of patients between third and fourth decade and an average of 33 years.⁷ Frankie Leung and Shew Ping chow accounted an average of 36 years (11-90 years).⁵ Chapman et al. noted about 78% males and 22% females.²⁵ Frankie-Leung series showed 82.6% males and 17.4% females⁷ In our study, male preponderance with 80% males and 20% female patients, which was comparable to previous studies. Moed BR et al. accounted 50% of his cases to RTA, 20% due to industrial accidents, 14% due to fall, 12% due to direct blow and 4% due to gunshot injuries.⁸ In the present study, RTA (60%), fall (30%) and assault (10%) of patients. Chapman et al. series noted about 53% of fractures as comminuted and 47% were transverse/short oblique.⁷ In present study accounted 75% of fractures as transverse/short oblique and 25% were comminuted . The results were not comparable to the previous studies, which can be attributed to low velocity trauma in our country Sarmiento A et al.⁹ noted about 84.6% of fracture on both bones were in middle third and 15.4% of cases had lower third fracture of both bones.¹⁹ Herbert Dodge and Cady GW documented 71.5% fracture on both bones in middle third, 21.5% in distal third and 7% in proximal third.¹⁰ In our series, we had 70% of fracture in middle third, 20% proximal and 10% in lower third. In the present study, there was one case of superficial infection. It was treated with appropriate antibiotics and the wound healed without any problem. There were two cases of posterior interosseous nerve palsy. These case was treated conservatively and there was spontaneous resolution of the nerve injury. We had a case of proximal radio-ulnar synostosis. We do not believe that this complication is related to the method of fixation, but rather to level of fracture and the degree of comminution. Chapman et al. and Anderson et al. noted similar complications. Anderson’s criteria for evaluation of union were taken into account. In our series, we had an average union time of 12.2 weeks, with the range of 9 to 28 weeks. We had 100% union of both radius and ulna. The results of our present study are comparable to the previous studies.^3,5,7 Fracture union and range of movements are the two factors, which affect the functional outcome. So early mobilization prevent soft tissue contracture, muscular tethering and improves the vascularity. Anderson’s et al. scoring system was used as a measure for the functional outcome.³ Anderson et al.³ reported about 54 (50.9%) cases as excellent, 37 (34.3%) satisfactory, 12 (11.3%) unsatisfactory and 2 (2.9%) as failure. Chapman et al.¹¹ reported about 36 (86%) cases as excellent, 3 (7%) satisfactory, 1 (2%) as unsatisfactory and 2 (5%) as failure. Frankie Leung reported 98% cases as excellent and 2% as satisfactory results.⁷ In present study, we had 26 (86.7%) with excellent results, 3 (10%) as satisfactory and 1 (3.3%) cases of unsatisfactory results. LC-DCP has got multiple advantages, since their interference with the periosteal circulation is less. They give good results. The rate of union is high, osteoporosis and refracture after removal is very low.

CONCLUSION

Advantages of LC-DCP, it facilitates biological fixation of the bone and early bone union. It is easier to apply in comminuted and segmental fracture and short oblique fractures. It gives excellent functional results in the majority of patients. Complication after a well-performed surgery are minor and easily correctable. Until newer implants are devised and extensively assessed as the versatile LC- DCP these should be used as the implant of choice for all closed displaced diaphyseal fractures of both bones forearm.

REFERENCES

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