Yao Chi-Kuo, Lin Kai-Cheng, Tarng Yih-Wen, Chang Wei-Ning, Renn Jenn-Hui
Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, 813, Taiwan.
Arch Orthop Trauma Surg. 2014 Dec;134(12):1691-7. doi: 10.1007/s00402-014-2079-4. Epub 2014 Aug 29.
Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal.
We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant.
There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, one patient was classified as type A1, one patient as type A2, two patients as type A3, and three patients as type B3. All patients suffered refracture without high-energy trauma. In group B, the refracture rate was 2.77 %, and all were caused by high-energy trauma. Patients with refracture had a shorter time interval between ORIF and implant removal. The possible risk factors of refracture in this study included a wedge bone defect on plain film, implant removal performed after less than 18 months, and AO/OTA type B fracture.
The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.
钢板固定是目前治疗前臂骨折的金标准，骨折愈合后是否取出内固定物仍存在争议。本研究展示了成年前臂骨折愈合后再骨折的一些病例，并探讨了决定是否取出内固定物的危险因素。
我们回顾了2008年1月至2011年5月在我院接受切开复位内固定术（ORIF）的前臂骨干骨折患者（包括桡骨、尺骨或双骨骨折）。骨折类型根据AO/OTA系统分类。所有患者均使用3.5毫米动力加压钢板固定。患者分为两个主要组：A组在骨折愈合后取出内固定物，B组保留内固定物。
本研究共纳入122例患者（170块骨）（女性40例，男性82例）。A组中，7/51例患者（8/62块骨；12.9%）发生再骨折。根据AO/OTA分类，1例患者为A1型，1例患者为A2型，2例患者为A3型，3例患者为B3型。所有患者均无高能创伤情况下发生再骨折。B组再骨折率为2.77%，均由高能创伤引起。发生再骨折的患者切开复位内固定术与取出内固定物之间的时间间隔较短。本研究中再骨折的可能危险因素包括X线平片显示楔形骨缺损、18个月内取出内固定物以及AO/OTA B型骨折。
保留内固定物组的再骨折发生率显著较低。由于再骨折率较高，不建议成年前臂骨折愈合后常规取出内固定物。
