Four-Screw Plate Fixation vs Conventional Fixation for Diaphyseal Fractures of the Forearm

Standard treatment of diaphyseal fractures of the forearm is open reduction and fixation using dynamic compression plates (DCP) and screws. This technique uses screw placement in all 6 or more of the plate holes except the hole over the fracture line. We hypothesized that DCP with selective 4-screw bicortical placement can provide adequate fixation for these fractures.

The aim of this study was to evaluate the results of conventional 6 or more screw fixation versus 4 screw fixation for adults with diaphyseal fractures of the forearm.

In this prospective study, 128 fractures of the ulna, radius or both bones of the forearm in 87 patients were treated in either one of these two groups: Open reduction and internal fixation (ORIF) with conventional DCP and screws or ORIF using DCP and selective 4- screw placement. Fractures were transverse or oblique in pattern without gross comminution. In a total of 41 patients with fractures, 28 single ulnar and 18 single radius fractures were included. Follow-up visits were done at 3-6 and 12-16 weeks and at 6 months. Outcome with respect to union an nonunion rates, union time, infection, and device failure was noted.

No change in alignment was noted in any patient. Union time in conventional and selective bicortical 4-screw fixation was 74.8 days and 73.6 days respectively which showed no significant difference (P = 0.064). Union rate and infection was 92.1% and 3.2% in conventional and 95.3% and 0% in the selective group respectively. Non-union was observed in 5 and 3 cases of fractures in conventional and the selective group respectively.

For treatment of the transverse or oblique diaphyseal fractures of the forearm, fixation by a same length 3.5 mm DCP with selective 4-screw cortical fixation (2 screws on each side of the fracture site) had similar results in comparison with conventional 6 or more DCP screws. Because of lesser impact on host bone and smaller incision, the selective 4-screw insertion can be an alternative technique for treatment of these fractures.