Tseng Tzu-Hao, Hung Chih-Chien, Yen Hung-Kuan, Chen Ho-Min, Wang Chen-Yu, Tzeng Shi-Chien, Fu Shau-Huai
Department of Orthopedic Surgery, National Taiwan University Hospital, No.7 Chungsan South Road, Taipei, 10002, Taiwan.
Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Yunlin County 632, Douliu, Taiwan.
J Orthop Traumatol. 2025 Feb 21;26(1):10. doi: 10.1186/s10195-025-00823-4.
Dynamic compression plate (DCP) osteosynthesis is the gold standard for treating forearm diaphyseal fractures, providing stability and promoting healing. Locking plates (LPs) are increasingly used in modern fracture management but may increase the risk of nonunion if applied with excessive rigidity and without proper fracture site compression. The purpose of this study is to compare the nonunion rate between LPs and DCPs.
We conducted a retrospective study by reviewing the medical records and radiographs of 515 patients diagnosed with radial and/or ulnar shaft fractures at three trauma centers between 2014 and 2019. Inclusion criteria were patients treated with locking plates (LPs), locking compression plates (LCPs), or dynamic compression plates (DCPs) who had at least 9 months of outpatient follow-up and imaging assessments. Exclusion criteria included treatment with other methods, hospitalization for pathological fractures or implant removal, or incomplete surgical records. Data on patient demographics, injury details, and surgical outcomes were collected to compare nonunion rates, as well as early and late complications, between the LP and DCP groups.
A total of 368 patients were included in the analysis. Among them, 132 (35.9%) had isolated radial shaft fractures, 116 (31.5%) had isolated ulnar shaft fractures, and 120 (32.6%) had both-bone fractures. Of these, 124 patients received LP implants, 98 were treated with LCPs, and 146 were treated with DCPs. Early complications were comparable among the groups; however, the nonunion rate was significantly higher in the LP group (18.5% versus 11.2% versus 6.2%, p < 0.007). Logistic regression identified LP use [odds ratio (OR): 3.05, 95% confidence interval (CI) 1.24-7.53] as a significant predictor of nonunion. Notably, LPs lacking dynamic compression functionality were associated with markedly higher odds of nonunion in radial shaft fractures (OR: 26.94, 95% CI 3.52-206.15). These findings collectively indicate that LPs increase the nonunion rate in forearm fractures.
Using LPs without compression functionality to treat forearm diaphyseal fractures increases the nonunion rate, particularly in radial shaft fractures. Therefore, we recommend using LCPs or DCPs for forearm diaphyseal fractures to ensure adequate compression at the fracture site during fixation, thereby promoting optimal bone healing rates.
Level III: retrospective comparative therapeutic study.
动力加压钢板（DCP）接骨术是治疗前臂骨干骨折的金标准，能提供稳定性并促进愈合。锁定钢板（LP）在现代骨折治疗中应用越来越广泛，但如果应用时过于僵硬且未对骨折部位进行适当加压，可能会增加骨不连的风险。本研究的目的是比较LP和DCP的骨不连发生率。
我们进行了一项回顾性研究，回顾了2014年至2019年间三个创伤中心515例诊断为桡骨和/或尺骨干骨折患者的病历和X线片。纳入标准为接受锁定钢板（LP）、锁定加压钢板（LCP）或动力加压钢板（DCP）治疗且门诊随访和影像学评估至少9个月的患者。排除标准包括采用其他方法治疗、因病理性骨折或取出内植物住院、或手术记录不完整。收集患者人口统计学、损伤细节和手术结果的数据，以比较LP组和DCP组之间的骨不连发生率以及早期和晚期并发症。
共有368例患者纳入分析。其中，132例（35.9%）为单纯桡骨干骨折，116例（31.5%）为单纯尺骨干骨折，120例（32.6%）为双骨折。其中，124例患者接受LP植入，98例采用LCP治疗，146例采用DCP治疗。各组早期并发症相当；然而，LP组的骨不连发生率显著更高（分别为18.5%、11.2%和6.2%，p＜0.007）。逻辑回归分析确定使用LP[比值比（OR）：3.05，95%置信区间（CI）1.24 - 7.53]是骨不连的显著预测因素。值得注意的是，缺乏动力加压功能的LP与桡骨干骨折骨不连的几率显著更高相关（OR：26.94，95%CI 3.52 - 206.15）。这些发现共同表明，LP会增加前臂骨折的骨不连发生率。
使用无加压功能的LP治疗前臂骨干骨折会增加骨不连发生率，尤其是在桡骨干骨折中。因此，我们建议使用LCP或DCP治疗前臂骨干骨折，以确保固定期间骨折部位有足够的加压，从而促进最佳的骨愈合率。
III级：回顾性对比治疗研究。
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