Anantavorasakul Navapong, Lans Jonathan, Wolvetang Nicolaas H A, Walbeehm Erik T, Chen Neal C
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Upper Extremity and Reconstructive Microsurgery Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand.
Arch Bone Jt Surg. 2022 Feb;10(2):153-159. doi: 10.22038/ABJS.2021.45901.2255.
Refracture after both bone forearm fracture fixation may vary with or without plate removal. We tested the null hypothesis that there is no difference in the rate of refracture in patients who have undergone open reduction and internal fixation of a diaphyseal forearm bone who have retained implants versus removed implants. We also studied factors associated with plate removal.
We retrospectively identified 645 adult patients with a total of 925 primary fractures that underwent primary plate fixation of an ulnar or radial shaft fracture between 2002 and 2015 at a single institutional system. Patients with nonunion, pathological fracture or infection were excluded. Independent factors associated with refracture and plate removal were identified using multivariable analysis.
Refractures occurred in 6.3% of the fractures that had forearm implant removal, compared to 2.1% of the fractures with retained plates. Refractures were independently associated with plate removal (OR: 3.7, 95% CI: 1.2-11.7, ) and was more frequent in the radius (OR: 2.4, 95% CI: 1.0-5.8, ). A refracture after implant removal occurred within 3 months after removal. Ulnar plates were removed more often compared to radial plates (OR: 2.6, 95% CI: 1.4-4.7, ) as were plates used for type A fractures compared to type C fractures (OR: 3.2, 95% CI: 1.1-9.2, ).
The rate of refracture is higher after plate removal compared to patients who did not have plates removed. Although uncommon, refractures of the radius tend to be more common than a refracture of the ulna. If the implant is symptomatic on the ulnar side, it may be preferable to remove the ulnar implant and retain the radius implant rather than remove both plates when possible. Furthermore, limiting strenuous activity for three months after implant removal is a consideration.
双侧前臂骨折固定术后再骨折情况可能因是否取出钢板而有所不同。我们检验了一个零假设，即对于接受骨干前臂骨切开复位内固定术且保留植入物与取出植入物的患者，其再骨折发生率无差异。我们还研究了与钢板取出相关的因素。
我们回顾性确定了645例成年患者，他们在2002年至2015年期间于单一机构系统接受了尺骨或桡骨干骨折的初次钢板固定，共925处原发性骨折。排除骨不连、病理性骨折或感染患者。使用多变量分析确定与再骨折和钢板取出相关的独立因素。
取出前臂植入物的骨折中，6.3%发生再骨折，而保留钢板的骨折中这一比例为2.1%。再骨折与钢板取出独立相关（比值比：3.7，95%置信区间：1.2 - 11.7），且在桡骨中更常见（比值比：2.4，95%置信区间：1.0 - 5.8）。植入物取出后再骨折发生在取出后3个月内。与桡骨钢板相比，尺骨钢板更常被取出（比值比：2.6，95%置信区间：1.4 - 4.7），与C型骨折相比，用于A型骨折的钢板也更常被取出（比值比：3.2，95%置信区间：1.1 - 9.2）。
与未取出钢板的患者相比，取出钢板后的再骨折发生率更高。虽然不常见，但桡骨再骨折往往比尺骨再骨折更常见。如果植入物在尺骨侧有症状，在可能的情况下，最好取出尺骨植入物并保留桡骨植入物，而不是同时取出两块钢板。此外，取出植入物后三个月内限制剧烈活动是一个需要考虑的因素。
