Departments of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Department of Orthopedic Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
BMC Musculoskelet Disord. 2023 Sep 14;24(1):731. doi: 10.1186/s12891-023-06857-1.
Segmental fractures often result from high-energy or indirect trauma that causes bending or torsional forces with axial loading. We evaluated surgical outcomes of patients with forearm segmental diaphyseal fractures.
We retrospectively analyzed data from patients with forearm segmental fractures for which they underwent surgery at the Pusan National University Trauma Center from March 2013 to March 2022. We also analyzed accompanying injuries, injury severity score (ISS), injury mechanism, occurrence of open fracture, surgical technique, and treatment results.
Fifteen patients were identified, one with bilateral segmental diaphyseal forearm bone fracture, for a total of 16 cases. Nine of the patients were male. The overall mean age was 50 years, and the mean follow-up period was 16.2 months. Six cases who underwent surgery using plate osteosynthesis achieved bone union without length deformity at final follow-up. Three of seven patients who underwent intramedullary nailing alone underwent reoperation due to nonunion. Six cases achieved bone union at final follow-up, three of which showed length deformity. Three patients underwent surgery using a hybrid method of IM nailing, plates, and mini cables. One patient who underwent surgery with a plate and one patient who underwent surgery with IM nailing alone showed nonunion and were lost to follow-up.
Plate osteosynthesis is considered the gold standard for treatment of adult forearm diaphyseal segmental fractures. In this study, IM nailing was associated with high rates of non-union and length deformity. However, the combination of IM nailing and a plate-cable system may be an acceptable alternative in segmental diaphyseal forearm fracture, achieving a union rate similar to that provided by plate fixation.
节段性骨折通常是由高能或间接创伤引起的，这种创伤会导致弯曲或扭转力，并伴有轴向载荷。我们评估了前臂节段骨干骨折患者的手术结果。
我们回顾性分析了 2013 年 3 月至 2022 年 3 月期间在釜山国立大学创伤中心接受手术治疗的前臂节段性骨折患者的数据。我们还分析了伴随损伤、损伤严重程度评分（ISS）、损伤机制、开放性骨折的发生、手术技术以及治疗结果。
共确定了 15 名患者，其中 1 名患者双侧前臂骨节段性骨折，总计 16 例。9 名患者为男性，总体平均年龄为 50 岁，平均随访时间为 16.2 个月。6 例采用钢板内固定术的患者在最终随访时均达到骨性愈合，无长度畸形。7 例单独采用髓内钉固定的患者中有 3 例因骨不连而再次手术。6 例患者在最终随访时达到骨性愈合，其中 3 例存在长度畸形。3 例患者采用 IM 钉、钢板和微型电缆的混合方法进行手术。1 例采用钢板和 1 例单独采用 IM 钉的患者出现骨不连并失访。
钢板内固定被认为是成人前臂骨干节段性骨折的金标准。在本研究中，髓内钉固定与较高的骨不连率和长度畸形相关。然而，IM 钉和钢板-电缆系统的联合应用可能是节段性前臂骨干骨折的一种可接受的替代方法，其愈合率与钢板固定相似。
