Mehdi Nasab Seyed Abdolhossein, Sarrafan Nasser, Sabahi Saeed
Department of Orthopaedic Surgery, Imam Khomeini Hospital, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
Trauma Mon. 2012 Spring;17(1):245-9. doi: 10.5812/traumamon.4497. Epub 2012 May 26.
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.
前臂骨干骨折的标准治疗方法是使用动力加压接骨板（DCP）和螺钉进行切开复位内固定。该技术是在除骨折线上方的孔之外的所有6个或更多的接骨板孔中置入螺钉。我们假设采用选择性双皮质4枚螺钉置入的DCP可为这些骨折提供足够的固定。
本研究的目的是评估成人前臂骨干骨折采用传统的6枚或更多螺钉固定与4枚螺钉固定的效果。
在这项前瞻性研究中，87例患者的128例尺骨、桡骨或前臂双骨骨折被分为以下两组之一进行治疗：采用传统DCP和螺钉进行切开复位内固定（ORIF），或采用DCP和选择性4枚螺钉置入进行ORIF。骨折类型为横行或斜行，无严重粉碎。共有41例骨折患者，其中包括28例单纯尺骨骨折和18例单纯桡骨骨折。在3 - 6周、12 - 16周以及6个月时进行随访。记录愈合和不愈合率、愈合时间、感染及内固定失败情况。
所有患者均未出现对线改变。传统固定和选择性双皮质4枚螺钉固定的愈合时间分别为74.8天和73.6天，差异无统计学意义（P = 0.064）。传统组的愈合率和感染率分别为92.1%和3.2%，选择性组分别为95.3%和0%。传统组和选择性组分别有5例和3例骨折出现不愈合。
对于前臂横行或斜行骨干骨折的治疗，采用相同长度的3.5 mm DCP并选择性进行4枚螺钉皮质固定（骨折部位两侧各2枚螺钉）与传统的6枚或更多DCP螺钉固定效果相似。由于对宿主骨的影响较小且切口更小，选择性4枚螺钉置入可作为治疗这些骨折的一种替代技术。
